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Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone
Background and Aims Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin
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| Published in: | Gastrointestinal endoscopy 2017-04, Vol.85 (4), p.794-802 |
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| container_title | Gastrointestinal endoscopy |
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| creator | Iranmanesh, Pouya, MD Tobler, Olivier, MD De Sousa, Sandra, MD Frossard, Jean-Louis, MD Morel, Philippe, MD Toso, Christian, MD, PhD |
| description | Background and Aims Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin |
| doi_str_mv | 10.1016/j.gie.2016.08.015 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835510583</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0016510716305211</els_id><sourcerecordid>1835510583</sourcerecordid><originalsourceid>FETCH-LOGICAL-c408t-1f4b87fad991931bda0d0af67432f754d2974788f44bb4156ee769afce8746943</originalsourceid><addsrcrecordid>eNp9kU-L1TAUxYMozps_H8CNZOmmNWnTJkUQZBgdYWAEdR3S9GbMm7Z5JumDfntveaMLF7PKhXvOCfd3CHnDWckZb9_vywcPZYVjyVTJePOC7DjrZNFK2b0kO4abouFMnpHzlPaMMVXV_DU5q2TTKs75jqzfYkgHsNkfgR7N6AeTfZhpcNTM1M8-ezNS-yuMYNeUURimlaYcTYaHlboQ6QEdMOdETUZDhjjB4HFdRJ8etyAbpgkjez8CHRab0R5muCSvnBkTXD29F-Tn55sf17fF3f2Xr9ef7gormMoFd6JX0pmh63hX834wbGDGtVLUlZONGKpOCqmUE6LvBW9aANl2xllQUrSdqC_Iu1PuIYbfC6SsJ58sjKOZISxJc1U3yKhRNUr5SWoRSorg9CH6ycRVc6Y34nqvkbjeiGumNBJHz9un-KXHw_85_iJGwYeTAPDIo4eok0VeFiFFxKmH4J-N__if247YijXjI6yQ9mGJM9LTXKdKM_19q3xrnLc1ayr8_g9HsagU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1835510583</pqid></control><display><type>article</type><title>Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone</title><source>ScienceDirect Journals</source><creator>Iranmanesh, Pouya, MD ; Tobler, Olivier, MD ; De Sousa, Sandra, MD ; Frossard, Jean-Louis, MD ; Morel, Philippe, MD ; Toso, Christian, MD, PhD</creator><creatorcontrib>Iranmanesh, Pouya, MD ; Tobler, Olivier, MD ; De Sousa, Sandra, MD ; Frossard, Jean-Louis, MD ; Morel, Philippe, MD ; Toso, Christian, MD, PhD</creatorcontrib><description>Background and Aims Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed shorter length of stay and fewer CBD investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines. Methods Initial cholecystectomy has become the standard management strategy at Geneva University Hospitals since July 2013 for patients at intermediate risk of CBD stones admitted with acute gallstone-related conditions. Between July 2013 and December 2014, length of stay, number of CBD investigations, and number of adverse events were recorded for these patients and compared with the data of the patients in the randomized controlled trial. Results Data for 161 consecutive newly assessed patients at intermediate risk of CBD stones confirmed shorter length of stay (7.6 vs 9.8 days; P < .001), fewer CBD investigations (0.8 vs 1.4 investigations per patient; P < .001), and similar adverse event rates (5.6% vs 14%, P = .14 including all adverse events; 3.1% vs 8%, P = .22 including only grade ≥III adverse events, defined by endoscopic/surgical reintervention or intensive care unit admission) compared with the previously reported group of patients who underwent preoperative CBD investigations. Conclusions These data confirm that initial cholecystectomy results in a shorter length of stay without increased morbidity among patients at intermediate risk of CBD stones compared with sequential CBD assessment and subsequent cholecystectomy. This approach may change current guidelines.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2016.08.015</identifier><identifier>PMID: 27568111</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase - blood ; Alkaline Phosphatase - blood ; Aspartate Aminotransferases - blood ; Bilirubin - blood ; Cholecystectomy, Laparoscopic - methods ; Choledocholithiasis - blood ; Choledocholithiasis - epidemiology ; Choledocholithiasis - surgery ; Endoscopy, Digestive System ; Female ; Gallstones - epidemiology ; Gallstones - surgery ; gamma-Glutamyltransferase - blood ; Gastroenterology and Hepatology ; Humans ; Length of Stay ; Lipase - blood ; Male ; Middle Aged ; Prospective Studies ; Risk Assessment</subject><ispartof>Gastrointestinal endoscopy, 2017-04, Vol.85 (4), p.794-802</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2017 American Society for Gastrointestinal Endoscopy</rights><rights>Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-1f4b87fad991931bda0d0af67432f754d2974788f44bb4156ee769afce8746943</citedby><cites>FETCH-LOGICAL-c408t-1f4b87fad991931bda0d0af67432f754d2974788f44bb4156ee769afce8746943</cites><orcidid>0000-0003-2136-1502 ; 0000-0002-6309-1603</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27568111$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iranmanesh, Pouya, MD</creatorcontrib><creatorcontrib>Tobler, Olivier, MD</creatorcontrib><creatorcontrib>De Sousa, Sandra, MD</creatorcontrib><creatorcontrib>Frossard, Jean-Louis, MD</creatorcontrib><creatorcontrib>Morel, Philippe, MD</creatorcontrib><creatorcontrib>Toso, Christian, MD, PhD</creatorcontrib><title>Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background and Aims Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed shorter length of stay and fewer CBD investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines. Methods Initial cholecystectomy has become the standard management strategy at Geneva University Hospitals since July 2013 for patients at intermediate risk of CBD stones admitted with acute gallstone-related conditions. Between July 2013 and December 2014, length of stay, number of CBD investigations, and number of adverse events were recorded for these patients and compared with the data of the patients in the randomized controlled trial. Results Data for 161 consecutive newly assessed patients at intermediate risk of CBD stones confirmed shorter length of stay (7.6 vs 9.8 days; P < .001), fewer CBD investigations (0.8 vs 1.4 investigations per patient; P < .001), and similar adverse event rates (5.6% vs 14%, P = .14 including all adverse events; 3.1% vs 8%, P = .22 including only grade ≥III adverse events, defined by endoscopic/surgical reintervention or intensive care unit admission) compared with the previously reported group of patients who underwent preoperative CBD investigations. Conclusions These data confirm that initial cholecystectomy results in a shorter length of stay without increased morbidity among patients at intermediate risk of CBD stones compared with sequential CBD assessment and subsequent cholecystectomy. This approach may change current guidelines.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alanine Transaminase - blood</subject><subject>Alkaline Phosphatase - blood</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Bilirubin - blood</subject><subject>Cholecystectomy, Laparoscopic - methods</subject><subject>Choledocholithiasis - blood</subject><subject>Choledocholithiasis - epidemiology</subject><subject>Choledocholithiasis - surgery</subject><subject>Endoscopy, Digestive System</subject><subject>Female</subject><subject>Gallstones - epidemiology</subject><subject>Gallstones - surgery</subject><subject>gamma-Glutamyltransferase - blood</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Lipase - blood</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kU-L1TAUxYMozps_H8CNZOmmNWnTJkUQZBgdYWAEdR3S9GbMm7Z5JumDfntveaMLF7PKhXvOCfd3CHnDWckZb9_vywcPZYVjyVTJePOC7DjrZNFK2b0kO4abouFMnpHzlPaMMVXV_DU5q2TTKs75jqzfYkgHsNkfgR7N6AeTfZhpcNTM1M8-ezNS-yuMYNeUURimlaYcTYaHlboQ6QEdMOdETUZDhjjB4HFdRJ8etyAbpgkjez8CHRab0R5muCSvnBkTXD29F-Tn55sf17fF3f2Xr9ef7gormMoFd6JX0pmh63hX834wbGDGtVLUlZONGKpOCqmUE6LvBW9aANl2xllQUrSdqC_Iu1PuIYbfC6SsJ58sjKOZISxJc1U3yKhRNUr5SWoRSorg9CH6ycRVc6Y34nqvkbjeiGumNBJHz9un-KXHw_85_iJGwYeTAPDIo4eok0VeFiFFxKmH4J-N__if247YijXjI6yQ9mGJM9LTXKdKM_19q3xrnLc1ayr8_g9HsagU</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Iranmanesh, Pouya, MD</creator><creator>Tobler, Olivier, MD</creator><creator>De Sousa, Sandra, MD</creator><creator>Frossard, Jean-Louis, MD</creator><creator>Morel, Philippe, MD</creator><creator>Toso, Christian, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2136-1502</orcidid><orcidid>https://orcid.org/0000-0002-6309-1603</orcidid></search><sort><creationdate>20170401</creationdate><title>Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone</title><author>Iranmanesh, Pouya, MD ; Tobler, Olivier, MD ; De Sousa, Sandra, MD ; Frossard, Jean-Louis, MD ; Morel, Philippe, MD ; Toso, Christian, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-1f4b87fad991931bda0d0af67432f754d2974788f44bb4156ee769afce8746943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alanine Transaminase - blood</topic><topic>Alkaline Phosphatase - blood</topic><topic>Aspartate Aminotransferases - blood</topic><topic>Bilirubin - blood</topic><topic>Cholecystectomy, Laparoscopic - methods</topic><topic>Choledocholithiasis - blood</topic><topic>Choledocholithiasis - epidemiology</topic><topic>Choledocholithiasis - surgery</topic><topic>Endoscopy, Digestive System</topic><topic>Female</topic><topic>Gallstones - epidemiology</topic><topic>Gallstones - surgery</topic><topic>gamma-Glutamyltransferase - blood</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Lipase - blood</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iranmanesh, Pouya, MD</creatorcontrib><creatorcontrib>Tobler, Olivier, MD</creatorcontrib><creatorcontrib>De Sousa, Sandra, MD</creatorcontrib><creatorcontrib>Frossard, Jean-Louis, MD</creatorcontrib><creatorcontrib>Morel, Philippe, MD</creatorcontrib><creatorcontrib>Toso, Christian, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iranmanesh, Pouya, MD</au><au>Tobler, Olivier, MD</au><au>De Sousa, Sandra, MD</au><au>Frossard, Jean-Louis, MD</au><au>Morel, Philippe, MD</au><au>Toso, Christian, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>85</volume><issue>4</issue><spage>794</spage><epage>802</epage><pages>794-802</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Background and Aims Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed shorter length of stay and fewer CBD investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines. Methods Initial cholecystectomy has become the standard management strategy at Geneva University Hospitals since July 2013 for patients at intermediate risk of CBD stones admitted with acute gallstone-related conditions. Between July 2013 and December 2014, length of stay, number of CBD investigations, and number of adverse events were recorded for these patients and compared with the data of the patients in the randomized controlled trial. Results Data for 161 consecutive newly assessed patients at intermediate risk of CBD stones confirmed shorter length of stay (7.6 vs 9.8 days; P < .001), fewer CBD investigations (0.8 vs 1.4 investigations per patient; P < .001), and similar adverse event rates (5.6% vs 14%, P = .14 including all adverse events; 3.1% vs 8%, P = .22 including only grade ≥III adverse events, defined by endoscopic/surgical reintervention or intensive care unit admission) compared with the previously reported group of patients who underwent preoperative CBD investigations. Conclusions These data confirm that initial cholecystectomy results in a shorter length of stay without increased morbidity among patients at intermediate risk of CBD stones compared with sequential CBD assessment and subsequent cholecystectomy. This approach may change current guidelines.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27568111</pmid><doi>10.1016/j.gie.2016.08.015</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2136-1502</orcidid><orcidid>https://orcid.org/0000-0002-6309-1603</orcidid></addata></record> |
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| ispartof | Gastrointestinal endoscopy, 2017-04, Vol.85 (4), p.794-802 |
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| language | eng |
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| subjects | Adult Aged Aged, 80 and over Alanine Transaminase - blood Alkaline Phosphatase - blood Aspartate Aminotransferases - blood Bilirubin - blood Cholecystectomy, Laparoscopic - methods Choledocholithiasis - blood Choledocholithiasis - epidemiology Choledocholithiasis - surgery Endoscopy, Digestive System Female Gallstones - epidemiology Gallstones - surgery gamma-Glutamyltransferase - blood Gastroenterology and Hepatology Humans Length of Stay Lipase - blood Male Middle Aged Prospective Studies Risk Assessment |
| title | Prospective validation of an initial cholecystectomy strategy for patients at intermediate-risk of common bile duct stone |
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