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Brian R Davidson - One of the best experts on this subject based on the ideXlab platform.
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early versus delayed laparoscopic cholecystectomy for uncomplicated Biliary Colic
Cochrane Database of Systematic Reviews, 2013Co-Authors: Kurinchi Selvan Gurusamy, Rahul S Koti, Giuseppe Fusai, Brian R DavidsonAbstract:Background Uncomplicated Biliary Colic is one of the commonest indications for laparoscopic cholecystectomy. Laparoscopic cholecystectomy involves several months of waiting if performed electively. However, people can develop life-threatening complications during this waiting period. Objectives To assess the benefits and harms of early versus delayed laparoscopic cholecystectomy for people with uncomplicated Biliary Colic due to gallstones. Search methods We searched the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2013. Selection criteria We included only randomised clinical trials, irrespective of language and publication status. Data collection and analysis Two authors independently extracted the data. We sought to include data on short-term mortality (30-day mortality or in-hospital mortality), bile duct injury, other serious adverse events, quality of life, conversion to open cholecystectomy, length of hospital stay, operating time, and return to work. We planned to calculate the risk ratio with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes using RevMan and based on intention-to-treat analysis when data were available. Since only one trial contributed data to this review, Fisher's exact test was used for binary outcomes. A P value of < 0.05 was considered statistically significant. Main results Only one trial including 75 participants (average age: 43 years; females: 65% of participants), randomised to early laparoscopic cholecystectomy (less than 24 hours after diagnosis) (n = 35) or delayed laparoscopic cholecystectomy (mean waiting period of 4.2 months) (n = 40), contributed information to this review. The trial had a high risk of bias. Information on the outcome mortality was available for the 75 participants. Information on serious adverse events was available for 68 participants (28 people in the early group and 40 people in the delayed group). The other outcomes were available for 28 participants in the early laparoscopic cholecystectomy group and 35 participants in the delayed laparoscopic cholecystectomy group. There were no deaths in the early group (0/35) (0%) versus 1/40 (2.5%) in the delayed laparoscopic cholecystectomy group (P > 0.9999). There was no bile duct injury in either group. There were no serious adverse events related to the surgery in either group. During the waiting period, complications developed in the delayed laparoscopic cholecystectomy group. The complications that the participants suffered included pancreatitis (n = 1), empyema of the gallbladder (n = 1), gallbladder perforation (n = 1), acute cholecystitis (n = 2), cholangitis (n = 2), obstructive jaundice (n = 2), and recurrent Biliary Colic (requiring hospital visits) (n = 5). In total, 14 participants required hospital admissions for the above symptoms. All of these admissions occurred in the delayed group as all the participants were operated on within 24 hours in the early group. The proportion of people who developed serious adverse events was 0/28 (0%) in the early group, which was significantly lower than in the delayed laparoscopic cholecystectomy group 9/40 (22.5%) (P = 0.0082). This trial did not report quality of life or return to work. There was no significant difference in the proportion of people who required conversion to open cholecystectomy in the early group 0/28 (0%) compared with the delayed group (6/35 or 17.1%) (P = 0.0743). There was a statistically significant shorter hospital stay in the early group than in the delayed group (MD -1.25 days, 95% CI -2.05 to -0.45). There was a statistically significant shorter operating time in the early group than the delayed group (MD -14.80 minutes, 95% CI -18.02 to -11.58). Authors' conclusions Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy (less than 24 hours after diagnosis of Biliary Colic) decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy (mean waiting time 4.2 months), the hospital stay, and operating time. Further randomised clinical trials are necessary to confirm or refute these findings, and to determine if early laparoscopic cholecystectomy is better than the delayed laparoscopic cholecystectomy if the waiting time is shortened further.
Kurinchi Selvan Gurusamy - One of the best experts on this subject based on the ideXlab platform.
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early versus delayed laparoscopic cholecystectomy for uncomplicated Biliary Colic
Cochrane Database of Systematic Reviews, 2013Co-Authors: Kurinchi Selvan Gurusamy, Rahul S Koti, Giuseppe Fusai, Brian R DavidsonAbstract:Background Uncomplicated Biliary Colic is one of the commonest indications for laparoscopic cholecystectomy. Laparoscopic cholecystectomy involves several months of waiting if performed electively. However, people can develop life-threatening complications during this waiting period. Objectives To assess the benefits and harms of early versus delayed laparoscopic cholecystectomy for people with uncomplicated Biliary Colic due to gallstones. Search methods We searched the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2013. Selection criteria We included only randomised clinical trials, irrespective of language and publication status. Data collection and analysis Two authors independently extracted the data. We sought to include data on short-term mortality (30-day mortality or in-hospital mortality), bile duct injury, other serious adverse events, quality of life, conversion to open cholecystectomy, length of hospital stay, operating time, and return to work. We planned to calculate the risk ratio with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes using RevMan and based on intention-to-treat analysis when data were available. Since only one trial contributed data to this review, Fisher's exact test was used for binary outcomes. A P value of < 0.05 was considered statistically significant. Main results Only one trial including 75 participants (average age: 43 years; females: 65% of participants), randomised to early laparoscopic cholecystectomy (less than 24 hours after diagnosis) (n = 35) or delayed laparoscopic cholecystectomy (mean waiting period of 4.2 months) (n = 40), contributed information to this review. The trial had a high risk of bias. Information on the outcome mortality was available for the 75 participants. Information on serious adverse events was available for 68 participants (28 people in the early group and 40 people in the delayed group). The other outcomes were available for 28 participants in the early laparoscopic cholecystectomy group and 35 participants in the delayed laparoscopic cholecystectomy group. There were no deaths in the early group (0/35) (0%) versus 1/40 (2.5%) in the delayed laparoscopic cholecystectomy group (P > 0.9999). There was no bile duct injury in either group. There were no serious adverse events related to the surgery in either group. During the waiting period, complications developed in the delayed laparoscopic cholecystectomy group. The complications that the participants suffered included pancreatitis (n = 1), empyema of the gallbladder (n = 1), gallbladder perforation (n = 1), acute cholecystitis (n = 2), cholangitis (n = 2), obstructive jaundice (n = 2), and recurrent Biliary Colic (requiring hospital visits) (n = 5). In total, 14 participants required hospital admissions for the above symptoms. All of these admissions occurred in the delayed group as all the participants were operated on within 24 hours in the early group. The proportion of people who developed serious adverse events was 0/28 (0%) in the early group, which was significantly lower than in the delayed laparoscopic cholecystectomy group 9/40 (22.5%) (P = 0.0082). This trial did not report quality of life or return to work. There was no significant difference in the proportion of people who required conversion to open cholecystectomy in the early group 0/28 (0%) compared with the delayed group (6/35 or 17.1%) (P = 0.0743). There was a statistically significant shorter hospital stay in the early group than in the delayed group (MD -1.25 days, 95% CI -2.05 to -0.45). There was a statistically significant shorter operating time in the early group than the delayed group (MD -14.80 minutes, 95% CI -18.02 to -11.58). Authors' conclusions Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy (less than 24 hours after diagnosis of Biliary Colic) decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy (mean waiting time 4.2 months), the hospital stay, and operating time. Further randomised clinical trials are necessary to confirm or refute these findings, and to determine if early laparoscopic cholecystectomy is better than the delayed laparoscopic cholecystectomy if the waiting time is shortened further.
Ertan Tatlicioglu - One of the best experts on this subject based on the ideXlab platform.
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urgent laparoscopic cholecystectomy is the best management for Biliary Colic a prospective randomized study of 75 cases
Digestive Surgery, 2005Co-Authors: Bulent Salman, Osman Yuksel, Oktay Irkorucu, Nusret Akyurek, Tugan Tezcaner, Ibrahim Dogan, Ozlem Erdem, Ertan TatliciogluAbstract:Background/Aim: Delay of laparoscopic cholecystectomy after the diagnosis of Biliary Colic may increase the probability of recurrent emergency admission while awaiting elective chol
Karel J Van Erpecum - One of the best experts on this subject based on the ideXlab platform.
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Biliary Colic is a valuable clinical descriptor for Biliary pain due to uncomplicated gallstone disease
Journal of Gastrointestinal Surgery, 2009Co-Authors: Marc G Besselink, Karel J Van ErpecumAbstract:We thank Drs Oria and Kohan for their interesting comments on our article: “Is complicated gallstone disease preceded by Biliary Colic?”1We found that 57% of 175 patients with complicated gallstone disease (including pancreatitis) had experienced Biliary Colics before the complication. In these cases, the complication could probably have been prevented by early cholecystectomy. However, significant patient’s and general practitioner’s delays had occurred after the “warning” Colic (especially if the pain was located in the epigastric region), thus precluding this option in practice. We agree with Drs Oria and Kohan that it is not possible to differentiate between Biliary Colic due to cystic duct obstruction by gallbladder stones and Biliary Colic caused by stones migrated to the bile duct. In fact, the term “Biliary Colic” does not pretend to make such differentiation. Although considered “a confounding term” by the authors, “Biliary Colic” is used frequently to describe Biliary pain due to “uncomplicated gallstone disease,” not only by this journal2 but also by other key journals3, 4 and the Cochrane database.5 Nevertheless, the “a priori” chance that gallbladder stones are the cause of Biliary Colic is much higher than bile duct stones, provided that significant abnormalities in liver biochemistry and clear bile duct dilatation by ultrasound are absent. Indeed, most episodes of Biliary Colic resolve spontaneously, without subsequent complications. Using various techniques including routine intraoperative cholangiography during cholecystectomy, frequency of unexpected bile duct stones in patients who have experienced Biliary Colics varies between 5% and 12%.6,7 These data indicate that bile duct stones are relatively rare in patients with Biliary Colics and/or that most bile duct stones migrate spontaneously to the duodenum. Oria and Kohan report interesting data on migration of bile duct stones in 39 patients with prior Biliary pain, using the time-honored technique of stool screening.8–10 In fact, their patients all had dilated bile ducts by ultrasound and may thus not be entirely representative of the entire population of patients with Biliary Colics. In addition, there is no solid evidence that early detection or bile duct stones by endoscopic ultrasound or magnetic resonance cholangiopancreatography would lead to a more beneficial outcome in the entire group of patients who have experienced Biliary Colics. If one assumes an a priori chance of 5% for bile duct stones under these circumstances and endoscopic ultrasound to have a sensitivity and specificity of 95%, positive predictive value of finding bile duct stones by endoscopic ultrasound would be only 50%. Subsequent endoscopic retrograde cholangiopancreatography would thus expose 50% of the patients to unnecessary risks of this procedure. In addition, the natural history of bile duct stones under these circumstances is uncertain.6, 7 The authors further state that “in order to prevent acute gallstone pancreatitis, early identification of patients undergoing anicteric episodes of gallstone migration is essential.” However, the evidence for this statement is lacking. No study has shown a reduction in incidence of Biliary pancreatitis by differentiating between cystic and main duct obstruction. In our opinion, additional investigations and treatment of bile duct stones in patients with Biliary Colics should be performed depending on the chance that bile duct stones are indeed present (for useful risk factors see Abboud et al.11) In contrast, as we conclude in our paper, a policy of timely referral and cholecystectomy of patients with Biliary Colic could prevent complicated gallstone disease, including Biliary pancreatitis in up to 50% of cases.
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is complicated gallstone disease preceded by Biliary Colic
Journal of Gastrointestinal Surgery, 2009Co-Authors: Marc G Besselink, Niels G Venneman, Ivo A M J Broeders, Peter D Siersema, Hein G Gooszen, Karel J Van ErpecumAbstract:Cholecystectomy in cases of “warning” episodes of Biliary Colic may prevent Biliary pancreatitis. We aimed to determine which proportion of patients with Biliary pancreatitis, compared to other complicated and uncomplicated symptomatic gallstone disease, experienced “warning” episodes of Colic and why these episodes did not lead to early cholecystectomy. One hundred seventy-five patients with complicated gallstone disease [pancreatitis (n = 53), symptomatic common bile duct (CBD) stones (n = 64), and acute cholecystitis (n = 58)] and 175 patients with symptomatic uncomplicated gallstones were interviewed at admission. Fifty-seven percent (100 of 175) of patients with complicated disease (95% confidence interval = 50–65%) experienced “warning” episodes of Biliary Colic (pancreatitis 58%, CBD stones 67%, cholecystitis 45%) vs 96% (164 of 175) in uncomplicated disease. Eighty-seven percent of patients with “warning” episodes and complicated disease experienced patient’s and general practitioner’s delays. General practitioner’s delay was more frequent if pain was located in the epigastric region compared to the right upper quadrant (51% vs 38%, P = 0.03). Half of patients with Biliary pancreatitis experience “warning” episodes of Biliary Colic, similar to other gallstone complications. In symptomatic patients, complications are often not prevented because of significant delays in diagnosis and treatment.
A Colli - One of the best experts on this subject based on the ideXlab platform.
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non steroid anti inflammatory drugs for Biliary Colic
Journal of Hepatology, 2017Co-Authors: Mirella Fraquelli, Dario Conte, Giovanni Casazza, A ColliAbstract:Background Cholelithiasis refers to the presence of gallstones, which are concretions that form in the Biliary tract, usually in the gallbladder. Cholelithiasis is one of the most common surgical problems worldwide and is particularly prevalent in most Western countries. Biliary Colic is the term used for gallbladder pain experienced by a person with gallstones and without overt infection around the gallbladder. It is the most common manifestation of cholelithiasis, observed in over one-third of people with gallstones over the course of 10 or more years. Non-steroid anti-inflammatory drugs (NSAIDs) have been widely used to relieve Biliary Colic pain, but their role needs further elucidation. They may decrease the frequency of short-term complications, such as mild form of acute cholecystitis, jaundice, cholangitis, and acute pancreatitis, but they may also increase the occurrence of more severe and possibly life-threatening adverse events such as gastrointestinal bleeding, renal function impairment, cardiovascular events, or milder events such as abdominal pain, drowsiness, headache, dizziness, or cutaneous manifestations. Objectives To assess the benefits and harms of NSAIDs in people with Biliary Colic. Search methods We searched the Cochrane Hepato-Biliary Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid SP), Embase (Ovid SP), Science Citation Index Expanded (Web of Science), and ClinicalTrials.gov until July 2016. We applied no language limitation. Selection criteria Randomised clinical trials recruiting participants presenting with Biliary Colic and comparing NSAIDs versus no intervention, placebo, or other drugs. Data collection and analysis Two review authors (MF and AC) independently identified trials for inclusion. We used risk ratios (RR) to express intervention effect estimates, and we analysed the data with both fixed-effect and random-effects model meta-analyses, depending on the amount of heterogeneity. We controlled random errors with Trial Sequential Analysis. We assessed the methodological quality of the evidence using GRADE criteria. Main results Twelve randomised clinical trials (RCTs) met our predefined review protocol criteria for analysis. We found only one trial to be at low risk of bias, considering the remaining trials to be at high risk of bias. The risk of selection bias in nine studies was unclear due to poor reporting, leading to uncertainty in the pooled effect estimates. Five trials compared NSAIDs versus placebo, four trials compared NSAID versus opioids, and four trials compared NSAID versus spasmolytic drugs (one of the 12 trials was a three-arm study comparing NSAIDs versus both opioids and spasmolytic drugs). There were 828 randomised participants (minimum 30 and maximum 324 per trial), of whom 416 received NSAIDs and 412 received placebo, spasmolytic drugs, or opioids. Twenty-four per cent of the participants were males. The age of the participants in the trials ranged from 18 to 86 years. All people were admitted to emergency departments for acute Biliary pain. There was no mortality. When compared with placebo, NSAIDs obtained a significantly lower proportion of participants without complete pain relief (RR 0.27, 95% confidence interval (CI) 0.19 to 0.40; I2 = 0%; 5 trials; moderate-quality evidence), which was confirmed by Trial Sequential Analysis, but not regarding participants with complications (RR 0.66, 95% CI 0.38 to 1.15; I2 = 26%; 3 trials; very low-quality evidence). NSAIDs showed more pain control than spasmolytic drugs (RR 0.51, 95% CI 0.37 to 0.71; I2 = 0%; 4 trials; low-quality evidence), which was not confirmed by Trial Sequential Analysis, and a significantly lower proportion of participants with complications (RR 0.27, 95% CI 0.12 to 0.57; I2 = 0%; 2 trials; low-quality evidence), which was also not confirmed by Trial Sequential Analysis. We found no difference in the proportions of participants without complete pain relief when comparing NSAIDs versus opioids (RR 0.98, 95% CI 0.47 to 2.07; I2 = 52%), suggesting moderate heterogeneity among trials (4 trials; very low-quality evidence). Only one trial comparing NSAIDs versus opioids reported results on complications, finding no significant difference between treatments. None of the included trials reported severe adverse events. Seven out of the 12 trials assessed non-severe adverse events: in two out of the seven trials, adverse events were not observed, and minor events were reported in the remaining five trials. In addition, we found one ongoing RCT assessing the analgesic efficacy of intravenous ibuprofen in Biliary Colic. Authors' conclusions NSAIDs have been assessed in relatively few trials including a limited number of participants for Biliary Colic, considering its common occurrence. We found only one trial to be at low risk of bias. There was no mortality. None of the included trials reported quality of life. The generalisability of the review is low as most of the RCTs included neither elderly people nor participants with comorbidities, who are more prone to complications as compared to others with Biliary Colic. The beneficial effect of NSAIDs compared with placebo on pain relief was confirmed when we applied Trial Sequential Analysis. The quality of evidence according to GRADE criteria was moderate for the comparison of NSAIDs versus placebo regarding the outcome lack of pain relief and low or very low for the other outcomes and comparisons. We found only one trial at low risk of bias, following the predefined 'Risk of bias' domains. We found the risk of selection bias to be unclear in nine studies due to poor reporting, leading to uncertainty in the pooled effect estimates.
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meta analysis nonsteroidal anti inflammatory drugs in Biliary Colic
Alimentary Pharmacology & Therapeutics, 2012Co-Authors: A Colli, Dario Conte, S Della Valle, V Sciola, Mirella FraquelliAbstract:Summary Background Biliary Colic is a common manifestation of cholelithiasis, developing in about one-third of patients. Even if nonsteroid anti-inflammatory drugs (NSAIDs) have widely been used to relieve Biliary pain, there is a lack of systematic review of treatments on this issue. Aim To assess the potential benefits in terms of both pain control and reduction of complications, and the potential harms of NSAIDs in patients with Biliary Colic. Methods Data from randomised clinical trials (RCTs) comparing NSAIDs with no treatment, placebo or other drugs in patients with Biliary Colic, were collected from Medline and Embase. The outcome measures were expressed as odds ratio and relative risk and then pooled using fixed or random-effect models. Results Eleven RCTs involving 1076 subjects (268 men, 808 women; 18–86 years), including 442 controls were analysed. In comparison with placebo, NSAIDs led to a significantly higher proportion of patients with complete pain relief (RR 3.77, 95%CI 1.65–8.61; I2: 73%) and a significantly lower rate of complications (RR 0.53, 95% CI 0.31–0.89; I2: 35%). In comparison with other drugs, NSAIDs were more efficacious in controlling pain than spasmolytics (RR 1.47, 95% CI 1.03–2.10; I2: 55%); there was no difference between NSAIDs and opioids (RR 1.05, 95% CI 0.82–1.33; I2: 74%). Conclusions In patients with Biliary Colic 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. However, the lack of high-quality RCTs and the presence of consistent heterogeneity among studies may partially flaw these results.