Cholezystolithiasis – ein Wandel im interdisziplinären Vorgehen?

Publisher： Karger

E-ISSN： 2297-475x|22|1|48-52

ISSN： 2297-4725

Source： Visceral Medicine (formerly: Viszeralmedizin), Vol.22, Iss.1, 2006-12, pp. : 48-52

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Abstract

Cholecystolithiasis has an enormous clinical and socioeconomicimpact due to its high prevalence and the risk to developsevere complications. 80% of persons with gallstones areasymptomatic at the time of diagnosis. After a first episode ofbiliary symptoms, about 70% of patients will experience recurrentbiliary symptoms within 2 years, and 1-2% per yearwill develop biliary complications. The diagnosis of gallstonedisease is made on the basis of the patient's history, a physicalexamination, an abdominal ultrasound, and laboratorytests to exclude complications such as cholecystitis, cholangitis,choledocholithiasis, and pancreatitis. Asymptomatic cholecystolithiasisis usually not treated. Exceptions are a porcelaingallbladder, simultaneous gallbladder polyps ‡ 10 mm,and gallstones > 3 cm due to the enhanced risk to developgallbladder carcinoma. In addition, prophylactic cholecystectomymay be considered in asymptomatic patients undergoingheart transplantation or surgery for morbid obesity.Laparoscopic cholecystectomy represents the first-line treatmentof symptomatic cholecystolithiasis. Nonsurgical treatmentwith ursodeoxycholic acid should only be considered inpatients with small (£ 5(-10) mm), mildly symptomatic gallbladderstones in a functioning gallbladder when surgery isrefused by the patient, surgical risk is high, or surgery is impossible.Extracorporeal shock wave lithotripsy of gallbladderstones is not recommended any more considering recurrencerates of 50-80% after 10 years.