Postcholecystectomy syndrome - an algorithmic approach

The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach. We evaluated 80 patients with postcholecystectomy problems...

Full description

Saved in:
Bibliographic Details
Published in:Journal of gastrointestinal and liver diseases : JGLD 2009-03, Vol.18 (1), p.67-71
Main Authors: Filip, Monalisa, Saftoiu, Adrian, Popescu, Carmen, Gheonea, Dan Ionut, Iordache, Sevastita, Sandulescu, Larisa, Ciurea, Tudorel
Format: Article
Language:English
Subjects:
Algorithms
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy - adverse effects
Endosonography
Female
Humans
Liver Function Tests
Male
Middle Aged
Postoperative Complications - diagnosis
Postoperative Complications - etiology
Postoperative Complications - therapy
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Syndrome
Treatment Outcome
Unnecessary Procedures
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach. We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months. In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP. An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.
ISSN:1841-8724