Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 3/2015

01-03-2015

Systematic review of the clinical and cost effectiveness of cholecystectomy versus observation/conservative management for uncomplicated symptomatic gallstones or cholecystitis

Authors: Miriam Brazzelli, Moira Cruickshank, Mary Kilonzo, Irfan Ahmed, Fiona Stewart, Paul McNamee, Andy Elders, Cynthia Fraser, Alison Avenell, Craig Ramsay

Published in: Surgical Endoscopy | Issue 3/2015

Login to get access

Abstract

Background

Gallstone disease is a common gastrointestinal disorder in industrialised countries. Although symptoms can be severe, some people can be symptom free for many years after the original attack. Surgery is the current treatment of choice, but evidence suggests that observation is also feasible and safe. We reviewed the evidence on cholecystectomy versus observation for uncomplicated symptomatic gallstones and conducted a cost-effectiveness analysis.

Methods

We searched six electronic databases (last search April 2014). We included randomised controlled trials (RCTs) or non-randomised comparative studies where adults received either cholecystectomy or observation/conservative management for the first episode of symptomatic gallstone disease (biliary pain or cholecystitis) being considered for surgery in secondary care. Meta-analysis was used to combine results. A de novo Markov model was developed to assess the cost effectiveness of the interventions.

Results

Two RCTs (201 participants) were included. Eighty-eight percent of people randomised to surgery and 45 % of people randomised to observation underwent cholecystectomy during the 14-year follow-up period. Participants randomised to observation were significantly more likely to experience gallstone-related complications (RR = 6.69, 95 % CI = 1.57–28.51, p = 0.01), in particular acute cholecystitis (RR = 9.55, 95 % CI = 1.25–73.27, p = 0.03), and less likely to undergo surgery (RR = 0.50, 95 % CI = 0.34–0.73, p = 0.0004) or experience surgery-related complications (RR = 0.36, 95 % CI = 0.16–0.81, p = 0.01) than those randomised to surgery. Fifty-five percent of people randomised to observation did not require surgery, and 12 % of people randomised to cholecystectomy did not undergo surgery. On average, surgery costs £1,236 more per patient than conservative management, but was more effective.

Conclusions

Cholecystectomy is the preferred treatment for symptomatic gallstones. However, approximately half the observation group did not require surgery or suffer complications indicating that it may be a valid alternative to surgery. A multicentre trial is needed to establish the effects, safety and cost effectiveness of observation/conservative management relative to cholecystectomy.
Appendix
Available only for authorised users
Literature
1.
Guidelines for the treatment of gallstones (1993) American college of physicians. Ann Int Med 119:620–622CrossRef
2.
Aerts R, Penninckx F (2003) The burden of gallstone disease in Europe. Aliment Pharmacol Ther 18(Suppl. 3):49–53PubMedCrossRef
3.
Kang JY, Ellis C, Majeed A, Hoare J, Tinto A, Williamsons RCN et al (2003) Gallstones—An increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 17:561–569PubMedCrossRef
4.
Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C et al (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122:1500–1511PubMedCrossRef
5.
6.
Halldestam I, Enell EL, Kullman E, Borch K (2004) Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 91:734–738PubMedCrossRef
7.
8.
Shaffer EA (2006) Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 20:981–996PubMedCrossRef
9.
Stinton LM, Myers RP, Shaffer EA (2010) Epidemiology of gallstones. Gastroenterol Clin N Am 39:157–169CrossRef
10.
Portincasa P, Di Ciaula A, Wang HH, Moschetta A, Wang DQH (2009) Medicinal treatments of cholesterol gallstones: old, current and new perspectives. Curr Med Chem 16:1531–1542PubMedCrossRef
11.
Attili AF, De Santis A, Capri R, Repice AM, Maselli S, Capocaccia L et al (1995) The natural history of gallstones: the GREPCO experience. Hepatology 21:656–660CrossRef
12.
Schmidt M, Hausken T, Glambek I, Schleer C, Eide GE, Sondenaa K (2011) A 24-year controlled follow-up of patients with silent gallstones showed no long-term risk of symptoms or adverse events leading to cholecystectomy. Scand J Gastroenterol 46:949–954PubMedCrossRef
13.
McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M (1985) The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 202:59–63PubMedCentralPubMedCrossRef
14.
Festi D, Reggiani MLB, Attili AF, Loria P, Pazzi P, Scaioli E et al (2010) Natural history of gallstone disease: expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 25:719–724PubMedCrossRef
15.
Friedman GD, Raviola CA, Fireman B (1989) Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol 42:1989CrossRef
16.
Sondenaa K, Nesvik I, Solhaug JH, Soreide O (1997) Randomization to surgery or observation in patients with symptomatic gallbladder stone disease: the problem of evidence-based medicine in clinical practice. Scand J Gastroenterol 32:611–616PubMedCrossRef
17.
Schmidt M, Dumot JA, Soreide O, Sondenaa K (2012) Diagnosis and management of gallbladder calculus disease. Scand J Gastroenterol 47:1257–1265PubMedCrossRef
18.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34PubMedCrossRef
19.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA G (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3:e123–e130PubMedCentralPubMed
20.
21.
Schmidt M, Sondenaa K, Vetrhus M, Berhane T, Eide GE (2011) A randomized controlled study of uncomplicated gallstone disease with a 14-year follow-up showed that operation was the preferred treatment. Dig Surg 28:270–276PubMedCrossRef
22.
Schmidt M, Sondenaa K, Vetrhus M, Berhane T, Eide GE (2011) Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: non-operative management is an option in some patients. Scand J Gastroenterol 46:1257–1262PubMedCrossRef
23.
Vetrhus M, Soreide O, Eide GE, Solhaug JH, Nesvik I, Sondenaa K (2004) Pain and quality of life in patients with symptomatic, non-complicated gallbladder stones: results of a randomized controlled trial. Scand J Gastroenterol 39:270–276PubMedCrossRef
24.
Vetrhus M, Soreide O, Solhaug JH, Nesvik I, Sondenaa K (2002) Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Scand J Gastroenterol 37:834–839PubMedCrossRef
25.
Vetrhus M, Soreide O, Nesvik I, Sondenaa K (2003) Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. Scand J Gastroenterol 38:985–990PubMed
26.
Vetrhus M, Soreide O, Eide GE, Nesvik I, Sondenaa K (2005) Quality of life and pain in patients with acute cholecystitis. Results of a randomized clinical trial. Scand J Surg 94:34–39PubMed
27.
Bass EB, Steinberg EP, Pitt HA, Griffiths RI, Lillemoe KD, Saba GP et al (1994) Comparison of the rating scale and the standard gamble in measuring patient preferences for outcomes of gallstone disease. Med Decis Mak 14:307–314CrossRef
28.
29.
Larsen TK, Qvist N (2007) The influence of gallbladder function on the symptomatology in gallstone patients, and the outcome after cholecystectomy or expectancy. Dig Dis Sci 52:760–763PubMedCrossRef
30.
Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JPH, Westert GP et al (2013) Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc 27:709–718PubMedCrossRef
31.
Bates T, Ebbs SR, Harrison M, A’Hern RP (1991) Influence of cholecystectomy on symptoms. Br J Surg 78:964–967PubMedCrossRef
32.
Borly L, Anderson IB, Bardram L, Christensen E, Sehested A, Kehlet H et al (1999) Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Scand J Gastroenterol 34:1144–1152PubMedCrossRef
33.
Gui GP, Cheruvu CV, West N, Sivaniah K, Fiennes AG (1998) Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up. Ann R Coll Surg Engl 80:25–32PubMedCentralPubMed
34.
Middelfart HV, Kristensen JU, Laursen CN, Qvist N, Hojgaard L, Funch-Jensen P et al (1998) Pain and dyspepsia after elective and acute cholecystectomy. Scand J Gastroenterol 33:10–14PubMedCrossRef
35.
Ure BM, Troidl H, Spangenberger W, Lefering R, Dietrich A, Eypasch EP et al (1995) Long-term results after laparoscopic cholecystectomy. Br J Surg 82:267–270PubMedCrossRef
36.
Ahmed R, Freeman JV, Ross B, Kohler B, Nicholl JP, Johnson AG (2000) Long term response to gallstone treatment—problems and surprises. Eur J Surg 166:447–454PubMedCrossRef
37.
Jorgensen T, Stubbe Teglbjerg J, Wille-Jorgensen P, Bille T, Thorvaldsen P (1991) Persisting pain after cholecystectomy. A prospective investigation. Scand J Gastroenterol 26:124–128PubMedCrossRef
38.
39.
Keus F, de Jong J, Gooszen HG, Laarhoven CJHM (2006) Small-incision versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev Issue 4:Art. No.: CD004788
40.
Keus F, De Jong JAF, Gooszen HG, van Laarhoven CJHM (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev Issue 4:Art. no. CD006231
41.
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev Issue 4:Art. no. CD006229
42.
43.
44.
Shao T, Yang YX (2005) Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 100:1813–1820PubMedCrossRef
Metadata
Title
Systematic review of the clinical and cost effectiveness of cholecystectomy versus observation/conservative management for uncomplicated symptomatic gallstones or cholecystitis
Authors
Miriam Brazzelli
Moira Cruickshank
Mary Kilonzo
Irfan Ahmed
Fiona Stewart
Paul McNamee
Andy Elders
Cynthia Fraser
Alison Avenell
Craig Ramsay
Publication date
01-03-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3712-6

Other articles of this Issue 3/2015

Surgical Endoscopy 3/2015 Go to the issue

OriginalPaper

Liquid-injection for preperitoneal dissection of transabdominal preperitoneal (TAPP) inguial hernia repair

OriginalPaper

The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats

OriginalPaper

Adenoma detection at colonoscopy by polypectomy in withdrawal only versus both insertion and withdrawal: a randomized controlled trial

OriginalPaper

The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia: a randomized double-blind, placebo-controlled trial

OriginalPaper

Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience

OriginalPaper

Surgical transgastric debridement of walled off pancreatic necrosis: an option for patients with necrotizing pancreatitis