Postcholecystectomy syndrome - an algorithmic approach.

BACKGROUND AND AIM 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. METHOD 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. RESULTS 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. CONCLUSION 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.

[1]  C. Lucas,et al.  Endoscopic sphincterotomy for stenosis of the sphincter of Oddi , 2001, Surgical Endoscopy.

[2]  D. Ledro-Cano.  Suspected choledocholithiasis: endoscopic ultrasound or magnetic resonance cholangio-pancreatography? A systematic review , 2007, European journal of gastroenterology & hepatology.

[3]  J. Lieb,et al.  Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography. , 2007, World journal of gastroenterology.

[4]  W. Foley,et al.  The Role of Sonography in Imaging of the Biliary Tract , 2007, Ultrasound quarterly.

[5]  J. Barkun,et al.  Nonoperative imaging techniques in suspected biliary tract obstruction. , 2006, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[6]  J. Lonovics,et al.  Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction: effect of papillotomy. , 2006, World journal of gastroenterology.

[7]  A. Gillams,et al.  Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III , 2006, Gut.

[8]  A. Saftoiu,et al.  The role of imaging methods in identifying the causes of extrahepatic cholestasis. , 2006, Journal of gastrointestinal and liver diseases : JGLD.

[9]  S. Mesenas.  Does the advent of endoscopic ultrasound (EUS) sound the death knell for endoscopic retrograde cholangiopancreatography (ERCP)? , 2006, Annals of the Academy of Medicine, Singapore.

[10]  M. Mercado.  [Gallbladder and Bile Ducts]. , 2006, Revista de gastroenterologia de Mexico.

[11]  B. Zilberstein,et al.  Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct , 2005 .

[12]  J. Varghese,et al.  Imaging patients with "post-cholecystectomy syndrome": an algorithmic approach. , 2005, Clinical radiology.

[13]  B. Zilberstein,et al.  Echo-endoscopy versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct. , 2005, Arquivos de gastroenterologia.

[14]  G. Mcentee,et al.  Cystic duct remnant and the 'post-cholecystectomy syndrome'. , 2004, Hepato-gastroenterology.

[15]  E. Buscarini,et al.  EUS for suspected choledocholithiasis: do benefits outweigh costs? A prospective, controlled study. , 2003, Gastrointestinal endoscopy.

[16]  L. Gandolfi,et al.  The role of ultrasound in biliary and pancreatic diseases. , 2003, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[17]  L. Yao,et al.  Endoscopic diagnosis and treatment of post-cholecystectomy syndrome. , 2003, Hepatobiliary & pancreatic diseases international : HBPD INT.

[18]  X Viviand,et al.  Complications of Endoscopic Sphincterotomy: Results From a Single Tertiary Referral Center , 2002, Endoscopy.

[19]  M. Tublin,et al.  Imaging the spectrum of biliary tract disease. , 2002, Radiologic clinics of North America.

[20]  L. Palazzo,et al.  EUS in common bile duct stones. , 2002, Gastrointestinal endoscopy.

[21]  A. Nowak,et al.  Accuracy of Linear Endoscopic Ultrasonography in the Evaluation of Patients with Suspected Common Bile Duct Stones , 2002, Endoscopy.

[22]  J. Sung,et al.  Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Abdominal Pain: What Makes Sense? , 2001, Endoscopy.

[23]  M. E. Ryan,et al.  An annotated algorithmic approach to malignant biliary obstruction. , 2001, Gastrointestinal endoscopy.

[24]  R. Carter,et al.  Brush cytology in the assessment of pancreatico–biliary strictures: a review of 406 cases , 2001, Journal of clinical pathology.

[25]  R. Erickson,et al.  EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice. , 2001, Gastrointestinal endoscopy.

[26]  P. Burns,et al.  Tissue harmonic imaging: is it a benefit for bile duct sonography? , 2001, AJR. American journal of roentgenology.

[27]  C. Crosta,et al.  Complications of diagnostic and therapeutic ERCP: a prospective multicenter study , 2001, American Journal of Gastroenterology.

[28]  H. Feußner,et al.  International Workshop on the clinical impact of endoscopic ultrasound in gastroenterology. , 2000, Endoscopy.

[29]  J. Varghese,et al.  Role of MR cholangiopancreatography in patients with failed or inadequate ERCP. , 1999, AJR. American journal of roentgenology.

[30]  S. Saini.  Imaging of the hepatobiliary tract. , 1997, The New England journal of medicine.

[31]  F. Oberti,et al.  Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic ultrasonography or retrograde cholangiography? Results of a prospective study. , 1997, Endoscopy.

[32]  F. Prat,et al.  Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis , 1996, The Lancet.

[33]  S. Chaussade,et al.  Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP. , 1995, Gastrointestinal endoscopy.

[34]  H. Dancygier,et al.  The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice. , 1994, Endoscopy.

[35]  D. Deziel.  Complications of cholecystectomy. Incidence, clinical manifestations, and diagnosis. , 1994, The Surgical clinics of North America.

[36]  V. Vilgrain,et al.  Diagnosis of choledocholithiasis by endoscopic ultrasonography. , 1994, Gastroenterology.

[37]  J. Siegel,et al.  Endoscopic ultrasonography compared with computed tomography with ERCP in patients with obstructive jaundice or small peri-pancreatic mass. , 1992, Gastrointestinal endoscopy.

[38]  K. Partanen,et al.  Diagnostic accuracy of ultrasound, computed tomography, and endoscopic retrograde cholangiopancreatography in the detection of obstructive jaundice. , 1991, Scandinavian journal of gastroenterology.

[39]  G. Mitchell.  Complication of cholecystectomy. , 1984, Southern medical journal.

[40]  L. Csink.  [Post-cholecystectomy syndrome]. , 1960, Orvosi hetilap.