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Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery

Received: 24 July 2024     Accepted: 20 August 2024     Published: 30 August 2024
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Abstract

Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.

Published in American Journal of Internal Medicine (Volume 12, Issue 3)
DOI 10.11648/j.ajim.20241203.11
Page(s) 26-32
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Asymptomatic Cholecystitis, Clinical Guidelines, Postcholecystectomy Syndrome, Cholecystectomy, Endoscopic Retrograde Cholangiopancreatography

References
[1] Podoluzhnyi V. I., Complications of gallstone disease, Fundamental and clinical medicine. 2011 Volume 2 No. 1 p. 102-114.
[2] Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982; 307(13): 798-800.
[3] Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989; 42(2): 127-136.
[4] Gallstone Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis and Choledocholithiasis. London: National Institute for Health and Care Excellence (NICE); October 2014.
[5] Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019; 51(5): 472-491.
[6] European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016; 65(1): 146-181.
[7] Borly L, Anderson IB, Bardram L, et al. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Scand J Gastroenterol. 1999; 34(11): 1144-1152.
[8] Okoro N, Patel A, Goldstein M, Narahari N, Cai Q. Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis. Gastrointest Endosc. 2008; 68(1): 69-74.
[9] Abeysuriya V, Deen KI, Navarathne NM. Biliary microlithiasis, sludge, crystals, microcrystallization, and usefulness of assessment of nucleation time. Hepatobiliary Pancreat Dis Int. 2010; 9(3): 248-253.
[10] Frossard JL, Hadengue A, Amouyal G, et al. Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc. 2000; 51(2): 175-179.
[11] Kusano T, Isa T, Ohtsubo M, Yasaka T, Furukawa M. Natural progression of untreated hepatolithiasis that shows no clinical signs at its initial presentation. J Clin Gastroenterol. 2001; 33(2): 114-117.
[12] Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Endoscopic retrograde cholangiopancreatography-related complications for bile duct stones in asymptomatic and symptomatic patients. JGH Open. 2021 Dec 2; 5(12): 1382-1390.
[13] Xu XD, Qian JQ, Dai JJ, Sun ZX. Endoscopic treatment for choledocholithiasis in asymptomatic patients. J Gastroenterol Hepatol. 2020; 35(1): 165-169.
[14] Hakuta R, Hamada T, Nakai Y, et al. Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes. J Gastroenterol. 2020; 55(1): 78-85.
[15] Attili AF, De Santis A, Capri R, Repice AM, Maselli S. The natural history of gallstones: the GREPCO experience. The GREPCO Group. Hepatology. 1995; 21(3): 655-660.
[16] Sayin SI, Wahlström A, Felin J, et al. Gut microbiota regulates bile acid metabolism by reducing the levels of tauro-beta-muricholic acid, a naturally occurring FXR antagonist. Cell Metab. 2013; 17(2): 225-235.
[17] Lemoinne S, Marteau P. Gut microbial profile in primary biliary cholangitis: Towards bioindicators. Clin Res Hepatol Gastroenterol. 2017; 41(5): 507-508.
[18] Song ST, Cai LY, Zeng X, Xie WF. Gut Microbial Profile in Asymptomatic Gallstones. Front Microbiol. 2022 Jun 13; 13: 882265.
[19] Fändriks L. Roles of the gut in the metabolic syndrome: an overview. J Intern Med. 2017; 281(4): 319-336.
[20] Song ST, Shi J, Wang XH, et al. Prevalence and risk factors for gallstone disease: A population-based cross-sectional study. J Dig Dis. 2020; 21(4): 237-245.
[21] Wang Q, Hao C, Yao W, Zhu D, Lu H, Li L, Ma B, Sun B, Xue D, Zhang W. Intestinal flora imbalance affects bile acid metabolism and is associated with gallstone formation. BMC Gastroenterol. 2020 Mar 6; 20(1): 59.
[22] Ridlon JM, Devendran S, Alves JM, Doden H, Wolf PG, Pereira GV, Ly L, Volland A, Takei H, Nittono H, Murai T, Kurosawa T, Chlipala GE, Green SJ, Hernandez AG, Fields CJ, Wright CL, Kakiyama G, Cann I, Kashyap P, McCracken V, Gaskins HR. The 'in vivo lifestyle' of bile acid 7α-dehydroxylating bacteria: comparative genomics, metatranscriptomic, and bile acid metabolomics analysis of a defined microbial community in gnotobiotic mice. Gut Microbes. 2020 May 3; 11(3): 381-404.
[23] Wu T, Zhang Z, Liu B, Hou D, Liang Y, Zhang J, Shi P. Gut microbiota dysbiosis and bacterial community assembly associated with cholesterol gallstones in large-scale study. BMC Genomics. 2013 Oct 1; 14: 669.
[24] Shrestha R, Chayaput P, Wongkongkam K, Chanruangvanich W. Prevalence and predictors of postcholecystectomy syndrome in Nepalese patients after 1 week of laparoscopic cholecystectomy: a cross-sectional study. Sci Rep. 2024 Feb 28; 14(1): 4903.
[25] Grigorieva I. N., Scherbakova L. V. Lipid profile in gallstone disease: new perspectives. Ateroscleroz. 2011; 7(1): 70-75. (In Russ.)
Cite This Article
  • APA Style

    Hosseini, S., Asadizeidabadi, A., Tarabrin, E., Muraviev, S., Orlushin, D. (2024). Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery. American Journal of Internal Medicine, 12(3), 26-32. https://doi.org/10.11648/j.ajim.20241203.11

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    ACS Style

    Hosseini, S.; Asadizeidabadi, A.; Tarabrin, E.; Muraviev, S.; Orlushin, D. Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery. Am. J. Intern. Med. 2024, 12(3), 26-32. doi: 10.11648/j.ajim.20241203.11

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    AMA Style

    Hosseini S, Asadizeidabadi A, Tarabrin E, Muraviev S, Orlushin D. Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery. Am J Intern Med. 2024;12(3):26-32. doi: 10.11648/j.ajim.20241203.11

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  • @article{10.11648/j.ajim.20241203.11,
      author = {Seyedmohammadamin Hosseini and Arya Asadizeidabadi and Evgeny Tarabrin and Sergey Muraviev and Denis Orlushin},
      title = {Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery
    },
      journal = {American Journal of Internal Medicine},
      volume = {12},
      number = {3},
      pages = {26-32},
      doi = {10.11648/j.ajim.20241203.11},
      url = {https://doi.org/10.11648/j.ajim.20241203.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20241203.11},
      abstract = {Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.
    },
     year = {2024}
    }
    

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    AU  - Seyedmohammadamin Hosseini
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    AB  - Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.
    
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