| Author/Editor | Vračko, J; Markovič, S; Wiechel, K-L | |
| Title | Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk | |
| Type | članek | |
| Source | Endoscopy | |
| Vol. and No. | Letnik 38, št. 8 | |
| Publication year | 2006 | |
| Volume | str. 773-8 | |
| Language | eng | |
| Abstract | Background and study aims: Surgery in elderly patients with acute cholecystitis is quite a high-risk procedure. The recent finding that activated pancreatic enzyme is present in sterile bile from the acutely inflamed gallbladder suggests that obstruction at the level of the common channel is a possible precipitating factor. It was therefore hypothesized that an initial endoscopic sphincterotomy in patients with acute cholecystitis might improve the clinical course. Patients and methods: A prospective unselected series of 105 patients over 65 years of age (52 men, 53 women; mean age 78) suffering from acute cholecystitis were initially treated on a random basis with either conservative methods or endoscopic sphincterotomy. Within the first 72 h after the onset of symptoms, all 52 patients in the endoscopic sphincterotomy group were managed by endoscopic retrograde cholangiopancreatography (ERCP), combined with endoscopic sphincterotomy in 50 cases. The main study parameter was the need for emergency cholecystectomy within the first week after admission. Results: Biliary sepsis requiring emergency surgery occurred in 15 patients in the conservatively treated group, in contrast with none of the 52 patients in the endoscopic sphincterotomy group (P < 0.001). latrogenic complications after endoscopic sphincterotomy occurred in three patients, one of whom required surgery, while two were managed by conservative means. The clinical course improved, avoiding the need for emergency cholecystectomy and other interventions, in 48 patients in the endoscopic sphincterotomy group and in 36 patients in the conservatively treated group (P < 0.01). (Abstract truncated at 2000 characters) | |
| Descriptors | CHOLECYSTITIS CHOLECYSTECTOMY CHOLELITHIASIS SPHINCTEROTOMY, ENDOSCOPIC CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE TREATMENT OUTCOME AGED |