ENDOSCOPIC TRANSPAPILLARY CATHETERIZATION OF THE GALLBLADDER FOLLOWED BY EXTERNAL SHOCK-WAVE LITHOTRIPSY AND SOLVENT INFUSION FOR THE TREATMENT OF GALLSTONE DISEASE

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%). Through an indwelling catheter, obstructed gallbladders were drained in 4 patients and combined treatment with ESWL and infused solvents was carried out in 18 patients. Combined treatment resulted in elimination of gallstones from the gallbladders of 14 of 18 patients (77.7%). Treatment was complicated by mild pancreatitis in only 1 of 20 successfully catheterized patients; there was no mortality

Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness

Contains fulltext : 117405.pdf (publisher's version ) (Closed access)BACKGROUND: Cholecystectomy is the preferred treatment option for symptomatic gallstones, but the exact relationship between cholecystectomies and symptoms still is unclear. This study aimed to assess the effectiveness of elective cholecystectomy for patients with cholecystolithiasis in terms of both persistent and de novo symptoms. METHODS: A systematic literature search was conducted in Pubmed and Embase. The search included studies comprising patients 18 years of age or older undergoing elective cholecystectomy for symptomatic cholecystolithiasis. The proportions of symptoms after cholecystectomy were calculated and then subdivided into persistent and de novo symptoms. RESULTS: A total of 38 studies reported the presence of postcholecystectomy symptoms. The results showed that upper abdominal pain, the main indication for cholecystectomy in the majority of the patients, mostly disappeared after surgery. However, it persisted in up to 33 % of the patients and arose de novo in up to 14 %. Diarrhea (85 %) and constipation (76 %) were the persistent symptoms most often reported, whereas upper abdominal pain and vomiting were the least often reported. Flatulence (62 %) was the most often reported new symptom. However, large variations in symptoms were found between studies. CONCLUSIONS: The review indicates that cholecystectomy often is ineffective with regard to persistent and de novo symptoms. The finding that the types and proportions of persistent symptoms differ from those that arise de novo suggests that this distinction may be useful in predicting which patients would and which would not benefit from a cholecystectomy