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Expert Review of Gastroenterology & Hepatology Volume 10, 2016 - Issue 1
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Reviews

Management of gallstones and its related complications

P PortincasaDepartment of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, ItalyCorrespondence[email protected]
,
A Di CiaulaDivision of Internal Medicine, Hospital of Bisceglie, Bisceglie, Italy
,
O de BariDepartment of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, Italy;Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
,
G GarrutiDepartment of Emergency and Organ Transplants, Section of Endocrinology, Andrology and Metabolic Diseases, University of Bari Medical School, Bari, Italy
,
VO PalmieriDepartment of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, Italy
&
DQ-H WangDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
Pages 93-112 | Published online: 11 Nov 2015

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*General indications for treatment of asymptomatic and symptomatic gallstones

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**In patients with biliary colic, nonsteroideal anti-inflammatory drugs (NSAIDs) are the first-choice treatments as they control pain with the same efficacy of opioids and significantly reduce the proportion of patients with severe complications. Need exists for more high-quality RCTs to reduce heterogeneity among studies

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**Detailed guidelines discussing the clinical application of laparoscopic biliary tract surgery. Elective cholecystectomy (by laparoscopy, small incision or open operation) is considered the definitive treatment of symptomatic and uncomplicated gallstones.

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**Very updated and critical review on standard and novel interventional approaches for gallstone disease, including natural orifice transluminal endoscopic surgery (NOTES). Advantages and disadvantages are discussed

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*The issue of early cholecystectomy during pregnancy as the optimal strategy to reduce antepartum and early postpartum admissions for uncomplicated symptomatic cholelithiasis, is addressed

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*Hypothesis that cholecystectomy is not totally harmless but may cause metabolic consequences in the long-term.

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*Interesting suggestion that cholecystectomy might be followed by dysregulation of the cholangiocyte-dependent secretion of the human fibroblast growth factor 19, bile acid metabolism and metabolic dysregulation

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*Historical paper. Characteristics of biliary pain are exactly defined

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*Discusses the old, recent and future perspectives on medical treatment of cholesterol cholelithiasis with special emphasis on oral litholysis and current restriction to a subgroup of selected patients

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**Management strategy for acute cholangitis and cholecystitis according to the severity assessment (Grade I, mild; Grade II, moderate; Grade III, severe)

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*Laparoscopic cholecystectomy performed within 2 days of presentation of acute cholecystitis yielded the best outcomes and lowest costs. Delaying laparoscopic cholecystectomy appears to be associated with more complications, higher mortality and higher cost

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*Laparoscopic cholecystectomy after drainage of the gall bladder has low morbidity with a relatively low conversion rate

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**In patients with gallbladder and common bile duct stones, intraoperative endoscopic sphincterotomy is as effective and safe as preoperative endoscopic sphincterotomy and results in a significantly shorter hospital stay. Authoritative analysis looking at data from randomized clinical trials and calculating risk ratios or mean differences with 95% confidence intervals based on intention-to-treat analysis

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**Recommendations concerning key aspects of medical and surgical management of acute pancreatitis. A reference standard for current management and guide future clinical research on acute pancreatitis

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*A comprehensive review focussing on the risks, management and outcomes for primary gallbladder carcinoma

*The analysis depicts current best practice to start adjuvant therapy for gallbladder cancer

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