Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 13

Abstract

Question: Is a wait-and-see policy better than a cholecystectomy within 6 weeks after endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and clearance of the common bile duct of stones? Design: Randomized controlled trial. Setting: A multicentre trial that included 1 academic centre and 8 community hospitals in The Netherlands. Patients: One hundred and twenty patients with proven gallbladder stones who underwent endoscopic sphincterotomy and stone extraction. Intervention: Patients were randomly allocated using a computer generated randomization scheme by an independent trial bureau to either a wait-and-see approach (n = 64) or laparoscopic cholecystecomy (n = 56). Outcome measure: At least 1 biliary event during a 2-year followup. Results: Twelve patients were lost to follow-up immediately. Of the 59 patients randomized to a waitand-see approach (and available for analysis), 27 (46%) had recurrent biliary symptoms versus 1 (2%) of 49 patients after laparoscopic cholecystectomy (LC) (risk ratio = 22.42, 95% confidence interval [CI] 3.16–159.14, p < 0.001). Twentytwo (81%) of the 27 wait-and-see patients underwent cholecystectomy, mainly for biliary pain (13 patients) or acute cholecystitis (7 patients). The rate of conversion to open cholecystectomy was 55% in patients allocated to the wait-and-see group compared with 23% for those who underwent immediate LC (p = 0.010). Conclusion: A wait-and-see policy after endoscopic sphincterotomy should not be recommended as Correspondence to: Ms. Marg McKenzie, RN, Administrative Assistant, CAGS-EBRS, Mount Sinai Hospital, 1560–600 University Ave., Toronto ON M5G 1X5; fax 416 586-5932; mmckenzie@mtsinai.on.ca Evidence-Based Surgery Chirurgie factuelle Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 13. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones Jeffrey Barkun, MD; Elijah Dixon, MD; Steven Strasberg, MD; for members of the Evidence Based Reviews in Surgery Group* *The Evidence Based Reviews in Surgery Group comprises Drs. J.S.T. Barkun, K. Brasel, G.W.N. Fitzgerald, H.J.A. Henteleff, A.W. Kirkpatrick, S. Latosinsky, H.M. MacRae, R.S. McLeod, L.A. Neumayer, D. Rogers, M.C. Taylor, E.M. Webber and Ms. M.E. McKenzie. CAGS Evidence Based Reviews in Surgery In September 2000, the Canadian Association of General Surgeons (CAGS) initiated a program titled CAGS Evidence Based Reviews in Surgery (CAGS-EBRS) to help practising clinicians improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. Both methodologic and clinical reviews of the article are made by experts in the relevant areas. The Canadian Journal of Surgery publishes 4 of these reviews per year. Each includes an abstract of the selected article and summarizes the methodologic and clinical reviews. We hope that readers will find these useful and learn skills that can be used to evaluate other articles. For more information about CAGS-EBRS or about participating in the program, email mmckenzie@mtsinai.on.ca the standard treatment since 46% had at least 1 more biliary event and 37% required cholecystectomy.

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@inproceedings{Barkun2005CanadianAO, title={Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 13}, author={Jeffrey Barkun}, year={2005} }