Pros and cons of treatment options for gallbladder disease

July 22, 2015, University of North Carolina Health Care

More than 25 million Americans have gallstones, and each year about 1 million new cases are diagnosed. Each year about 1.8 million people develop abdominal pain as a result of gallstones and go see a doctor about it. About 40 percent of these, more than 725,000 people a year, ultimately have surgery to resolve the problem.

A new review article, published in the July 23, 2015 issue of The New England Journal of Medicine, analyzes the pros and cons of five different interventional approaches to gallbladder disease.

Todd H. Baron, MD, Professor and Director of Advanced Endoscopy in the Division of Gastroenterology and Hepatology in the University of North Carolina School of Medicine, is lead author of the article.

"With the recent technological advances in endoscopic treatments for symptomatic gallbladder disease, we believed that it was important to communicate the potential for recently developed means for managing this common disease to the broader medical community," Baron said.

Co-authors of the article are Ian S. Grimm, MD, Professor and Director of GI Procedures at UNC; and Lee L. Swanstrom, MD, of the Oregon Clinic in Portland, Oregon.

The most common intervention in use today is laparoscopic cholecystectomy, a surgical removal of the gallbladder using minimally invasive laparoscopic techniques. This approach was introduced in 1985 as an alternative to traditional open surgery, which is still required in a small number of cases. The advantages of the include little or no visible scarring, but it is sometimes technically difficult to perform in patients with severe cholecystitis or prior abdominal surgery.

A more recently developed surgical technique is natural orifice transluminal endoscopic surgery, or NOTES In NOTES, the surgeon accesses the gallbladder by using an endoscope that enters the body through a naturally occurring opening such as the mouth, vagina or anus. A major advantage to this approach is that it requires no incision, but it requires special equipment and is technically very difficult, and for those reasons is available at only a few select medical centers.

Percutaneous cholecystosomy is another option available for patients who are not suitable candidates for the laparoscopic approach. In this technique, a pigtail catheter is placed through the abdominal wall directly into the gallbladder to allow for drainage of bile through the tube and outside the body. This approach is effective in resolving cholecystitis for about 90 percent of patients who receive it, but the external drainage tubes are uncomfortable for patients, which can have a detrimental effect on their quality of life.

Endoscopic procedures for drainage of the gallbladder can also be performed via oral, upper endoscopic techniques, using either the transpapillary route or the transmural route. In both cases, bile drains from the gallbladder directly into the patient's gastrointestinal tract where it functions principally as an aid to digestion. Both of these approaches eliminate the problems associated with external drainage tubes, and with the loss of bile, fluid, and electrolytes. The transpapillary approach has been feasible for years, but it is technically difficult and thus is not widely used.

The most recent minimally invasive approach to treatment of gallstone disease is the endoscopic transmural drainage approach. Performed primarily by gastroenterologists, this approach utilizes endoscopic ultrasound guidance to puncture the gallbladder through the stomach or duodenum. A self-expandable metal stent is then deployed to maintain internal bile drainage. Placement of newly developed large diameter stents also allows for the endoscopic extraction of gallstones, in selected cases. Together, Drs. Baron - who came to UNC from the Mayo Clinic in 2014 - and Dr. Grimm have performed endoscopic transmural gallbladder drainage in about 20 patients over the past year.

The transmural approach is not yet widely available, and long-term and comparative outcome data to other approaches are needed, but Drs Baron and Grimm anticipate significant potential for growth in this area as the technology continues to evolve, and performing the technique becomes both easier and faster.

This transmural approach is exciting and offers an internal, nonoperative approach to the treatment of disease in patients who are considered non-surgical candidates, It is especially attractive for those patients who might otherwise be treated with percutaneous drainage, since external tubes commonly become dislodged and have a negative impact on quality of life.

Explore further: Laparoscopic surgical removal of the gallbladder in pediatric patients is safe

Related Stories

Laparoscopic surgical removal of the gallbladder in pediatric patients is safe

August 7, 2014
A recent study conducted by Mayo Clinic researchers recommends laparoscopic cholecystectomies (surgical removal of the gallbladder) for pediatric patients suffering from gallstones and other gallbladder diseases. This study ...

Study finds gallbladder surgery can wait

September 23, 2014
Laparoscopic cholecystectomy, a minimally invasive procedure to remove the gallbladder, is one of the most common abdominal surgeries in the U.S. Yet medical centers around the country vary in their approaches to the procedure ...

Pain characteristics suggest higher benefit from gallbladder surgery

October 12, 2011
According to a new study in Clinical Gastroenterology and Hepatology, better understanding of a patient's abdominal pain could help physicians know which patients will benefit most from surgical removal of the gallbladder. ...

Study examines endoscopic ultrasound-guided drainage of pancreatic pseudocysts

October 21, 2013
Researchers report that in patients with pseudocysts with viscous debris-laden fluid, endoscopic ultrasound-guided drainage by using a combination of a nasocystic drain and transmural stents improves clinical outcomes and ...

Recommended for you

'Life support' for transplant livers better than freezing: study

April 18, 2018
Keeping transplant livers on "life support" at body temperature preserves them better than the prevailing method of near-freezing, and could reduce the number of donor organs thrown away, a study said Wednesday.

Study finds no evidence that anesthesia in young children lowers intelligence

April 18, 2018
A Mayo Clinic study finds no evidence that children given anesthesia before their third birthdays have lower IQs than those who did not have it. A more complex picture emerges among people who had anesthesia several times ...

Post-surgical opioids can, paradoxically, lead to chronic pain

April 16, 2018
Giving opioids to animals to quell pain after surgery prolongs pain for more than three weeks and primes specialized immune cells in the spinal cord to be more reactive to pain, according to a new study by the University ...

Evidence mounts that daily opioid users may fare worse after spine surgery, study finds

April 16, 2018
In a multicenter database study of adults who had undergone surgery for spinal deformities, researchers say that those who had used narcotics daily on average had worse outcomes, such as longer intensive care unit stays and ...

Whether the donor and recipient are male or female influences transplant rejection rates—investigators explore why

March 22, 2018
Biological sex differences can have far-reaching, clinical consequences, as illustrated by organ transplant outcomes. Men and women who receive donated organs can have different rates of transplant rejection, in some cases ...

Surgeon performance benefits from 'warm-up'

March 20, 2018
Surgeons progressively 'warm-up' as they repeat a procedure on their operating list, akin to the way athletes' performance improves across a competition—according to new research.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.