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Gallstone disease: Optimal timing of treatment

  • Philipp-Robert Scherber
    Affiliations
    Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University, Saarland University Medical Center, Homburg, Germany
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  • Frank Lammert
    Correspondence
    Corresponding author. Address: Department of Medicine II, Saarland University, Saarland University Medical Center, 66421 Homburg, Germany. Tel.: +49 6841 16 23201; fax: +49 6841 16 23267.
    Affiliations
    Department of Medicine II, Saarland University, Saarland University Medical Center, Homburg, Germany
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  • Matthias Glanemann
    Affiliations
    Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University, Saarland University Medical Center, Homburg, Germany
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      Gallstones are common and affect up to 20% of the European population. In general, symptomatic gallstones represent an indication for treatment. The European Association for the Study of the Liver has published the latest Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.
      • Lammert F.
      • Acalovschi M.
      • Ercolani G.
      • van Erpecum K.
      • Gurusamy K.S.
      • van Laarhoven C.J.
      EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.
      In this Snapshot, we visualize the current treatment algorithms and discuss the optimal timing of the recommended interventions. These recommendations are based on new randomized controlled clinical trials in patients with biliary symptoms or complications. Although the genetics and pathophysiology of gallstones have been clarified, medical preventive measures would be too complex and expensive and the treatment algorithms remain predominantly invasive and based on surgery.
      • Lammert F.
      • Gurusamy K.
      • Ko C.W.
      • Miquel J.F.
      • Méndez-Sánchez N.
      • Portincasa P.
      • et al.
      Gallstones.
      Therefore future studies should focus on preventive strategies to overcome the onset of gallstones, particularly in at-risk patients, but also in the general population.
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      References

        • Lammert F.
        • Acalovschi M.
        • Ercolani G.
        • van Erpecum K.
        • Gurusamy K.S.
        • van Laarhoven C.J.
        EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.
        J Hepatol. 2016; 65: 146-181
        • Lammert F.
        • Gurusamy K.
        • Ko C.W.
        • Miquel J.F.
        • Méndez-Sánchez N.
        • Portincasa P.
        • et al.
        Gallstones.
        Nat Rev Dis Primers. 2016; 2: 16024
        • Beuers U.
        • Boberg K.M.
        • Chapman R.W.
        • Chazouillères O.
        • Invernizzi P.
        • Jones D.E.
        • et al.
        EASL Clinical Practice Guidelines: Management of cholestatic liver diseases.
        J Hepatol. 2009; 51: 237-267
        • Gurusamy K.S.
        • Koti R.
        • Fusai G.
        • Davidson B.R.
        Early vs. delayed laparoscopic cholecystectomy for uncomplicated biliary colic.
        Cochrane Database Syst Rev. 2013; 6: CD007196
        • Lamberts M.P.
        • Den Oudsten B.L.
        • Keus F.
        • De Vries J.
        • van Laarhoven C.J.
        • Westert G.P.
        • et al.
        Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up: a long-term prospective cohort study.
        Surg Endosc. 2014; 28: 3443-3450
        • Riall T.S.
        • Adhikari D.
        • Parmar A.D.
        • Linder S.K.
        • Dimou F.M.
        • Crowell W.
        • et al.
        The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications.
        J Am Coll Surg. 2015; 220: 682-690
        • Gutt C.N.
        • Encke J.
        • Köninger J.
        • Harnoss J.C.
        • Weigand K.
        • Kipfmüller K.
        • et al.
        Acute cholecystitis: early vs. delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304).
        Ann Surg. 2013; 258: 385-393
        • Banz V.
        • Gsponer T.
        • Candinas D.
        • Güller U.
        Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.
        Ann Surg. 2011; 254: 964-970
        • Rajcok M.
        • Bak V.
        • Danihel L.
        • Kukucka M.
        • Schnorrer M.
        Early vs. delayed laparoscopic cholecystectomy in treatment of acute cholecystitis.
        Bratisl Lek Listy. 2016; 117: 328-331
        • Da Costa D.W.
        • Bouwense S.A.
        • Schepers N.J.
        • Besselink M.G.
        • van Santvoort H.C.
        • van Brunschot S.
        • et al.
        Same-admission vs. interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial.
        Lancet. 2015; 386: 1261-1268
        • Reinders J.S.
        • Goud A.
        • Timmer R.
        • Kruyt P.M.
        • Witteman B.J.
        • Smakman N.
        • et al.
        Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis.
        Gastroenterology. 2010; 138: 2315-2320
        • Nealon W.H.
        • Bawduniak J.
        • Walser E.M.
        Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections.
        Ann Surg. 2004; 239: 741-749