Our Summary

This study compared two different methods of treating acute cholecystitis, which is a sudden inflammation of the gallbladder.

The first method involved inserting a stent into the gallbladder through an endoscope (a procedure known as endoscopic gallbladder stenting or EGBS) to treat the inflammation, and then later removing the gallbladder in a planned (elective) surgery.

The second method was to remove the gallbladder immediately (immediate cholecystectomy or IC) during hospitalization without any prior treatment.

503 patients were included in the study. After using statistical methods to ensure the two groups were comparable, there were 57 pairs of patients, one undergoing EGBS and the other undergoing IC.

The results showed that more patients in the EGBS group had their gallbladders removed using a laparoscope (a less invasive procedure) compared to the IC group. In addition, the amount of blood loss was significantly less in the EGBS group compared to the IC group.

The study concluded that treating acute cholecystitis initially with EGBS and then removing the gallbladder in a planned surgery after the inflammation has disappeared is a safer and less invasive approach compared to immediate removal of the gallbladder.

FAQs

  1. What are the two methods of treating acute cholecystitis discussed in the study?
  2. What were the differences in outcomes between the endoscopic gallbladder stenting (EGBS) and the immediate cholecystectomy (IC) groups in the study?
  3. Based on the study, which method of treating acute cholecystitis is considered safer and less invasive?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cholecystectomy is that in cases of acute cholecystitis, it may be beneficial to first undergo endoscopic gallbladder stenting (EGBS) to treat the inflammation before proceeding with a planned cholecystectomy. This approach can result in a safer and less invasive procedure with potentially less blood loss compared to immediate removal of the gallbladder. It is important to discuss with your healthcare provider to determine the best treatment plan for your individual situation.

Suitable For

Patients who are typically recommended for cholecystectomy include those with:

  1. Gallstones causing symptoms such as abdominal pain, nausea, and vomiting
  2. Acute cholecystitis (inflammation of the gallbladder)
  3. Chronic cholecystitis (long-term inflammation of the gallbladder)
  4. Gallbladder polyps
  5. Biliary dyskinesia (gallbladder dysfunction)
  6. Pancreatitis caused by gallstones
  7. Gallbladder cancer

Ultimately, the decision to recommend cholecystectomy is made on a case-by-case basis by a healthcare provider based on the patient’s symptoms, overall health, and the underlying cause of their gallbladder condition.

Timeline

Before cholecystectomy:

  • Patient experiences symptoms of acute cholecystitis such as severe abdominal pain, nausea, vomiting, and fever.
  • Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the diagnosis.
  • Treatment may involve hospitalization, antibiotics, and pain management.
  • In the case of this study, patients may undergo EGBS as initial treatment to reduce inflammation in the gallbladder.

After cholecystectomy:

  • Patient undergoes either EGBS followed by planned cholecystectomy or immediate cholecystectomy.
  • Recovery time post-surgery varies but generally includes pain management, monitoring for complications, and follow-up appointments.
  • Patients may need to modify their diet and lifestyle to accommodate the absence of the gallbladder.
  • In this study, patients who underwent EGBS followed by planned cholecystectomy had less blood loss and a lower rate of laparoscopic gallbladder removal compared to those who had immediate cholecystectomy.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing endoscopic gallbladder stenting (EGBS) followed by a planned cholecystectomy compared to immediate cholecystectomy (IC)?
  2. How long does the recovery process typically take for each method of treatment?
  3. What are the potential complications of each treatment option?
  4. Are there any long-term effects or implications of choosing one treatment method over the other?
  5. How do the costs of the two treatment options compare?
  6. What is the success rate of each treatment method in resolving acute cholecystitis?
  7. How soon after the initial treatment (EGBS or IC) can I expect to have my gallbladder removed?
  8. Will I have any dietary restrictions or lifestyle changes to consider after the gallbladder removal surgery?
  9. Are there any alternative treatment options for acute cholecystitis that I should be aware of?
  10. How will I be monitored for any potential complications or recurrence of acute cholecystitis after treatment?

Reference

Authors: Kobayashi S, Nakahara K, Umezawa S, Ida K, Tsuchihashi A, Koizumi S, Sato J, Tateishi K, Otsubo T. Journal: Surg Laparosc Endosc Percutan Tech. 2024 Apr 1;34(2):171-177. doi: 10.1097/SLE.0000000000001252. PMID: 38260964