Skip to main content
SpringerLink
Log in

Choledocho- und Cholezystolithiasis

Aktuelle leitliniengerechte Versorgung

Gallstone disease

Up-to-date guideline-based management

  • Schwerpunkt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Hintergrund

Etwa 10–20 % der deutschen Bevölkerung sind Gallensteinträger, davon entwickelt bis zu einem Viertel während ihrer Lebenszeit Symptome oder Komplikationen.

Fragestellung

Die Übersicht stellt auf der Grundlage aktueller Leitlinien die evidenzbasierte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis dar.

Material und Methoden

Die relevanten Empfehlungen der zur Publikation anstehenden aktualisierten S3-Leitlinie zur Diagnostik und Therapie von Gallensteinen werden kommentiert und Weiterentwicklungen zur im Jahr 2007 publizierten Fassung aufgezeigt. Ergänzend werden auch Empfehlungen der S2k-Leitlinie zu Qualitätsanforderungen an die gastrointestinale Endoskopie und der Leitlinien der European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) zur interventionellen Sonographie bei Patienten mit Gallensteinleiden aufgegriffen.

Ergebnisse

Auf der Grundlage aktueller Evidenz sind die Leitlinienempfehlungen zur Diagnostik und Therapie von Patienten mit Cholezysto- und Choledocholithiasis präzisiert worden. Die Anforderungen an eine frühzeitige operative Versorgung von Patienten mit akuter Cholezystitis (24 h), an das zeitgerechte Management von Patienten mit akuter Cholangitis und biliärer Pankreatitis (abhängig vom Schweregrad) und an die sequenzielle Therapie von Patienten mit simultaner Cholezysto- und Choledocholithiasis (laparoskopische Cholezystektomie innerhalb von 72 h nach endoskopischer Gangsanierung) steigen.

Schlussfolgerungen

Die aktuelle leitliniengerechte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis ist interdisziplinär und erfordert integrierte viszeralmedizinische Betreuungskonzepte, die zusammenfassend in einem Algorithmus dargestellt werden.

Abstract

Background

Gallstones are present in approximately 10–20 % of the German population. Up to one fourth of them will develop symptoms or complications during their lifetime.

Objective

Based on recent guidelines, this paper reviews the evidence-based management of patients with gallstone disease.

Materials and methods

Most relevant recommendations of the updated S3 guidelines on the diagnosis and treatment of gallstone disease are provided. Developments are depicted in relation to the 2007 version of these guidelines. Complementary recommendations of the S2k guidelines on quality requirements for gastrointestinal endoscopy and of the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) guidelines on interventional ultrasound in gallstone disease are referred to.

Results

Based on recent scientific evidence, the guideline recommendations for diagnosis and treatment of patients with gallstone disease are presented. Requirements are rising for early surgical treatment of patients with acute cholecystitis (24 h), the timely management of patients with acute cholangitis and biliary pancreatitis (depending on severity) and on the sequential treatment of patients with simultaneous gallbladder and common bile duct stones (laparascopic cholecystectomy within 72 h after endoscopic bile duct clearance).

Conclusions

Up-to-date guideline-based management of patients with gallstone disease is an interdisciplinary task and requires comprehensive management concepts. A guideline-based algorithm is introduced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Lehmann KS, Zornig C, Arlt G, Butters M, Bulian DR, Manger R, Burghardt J et al (2015) Natural orifice transluminal endoscopic surgery in Germany: data from the German NOTES registry. Chirurg 86:577–586

    Article  CAS  PubMed  Google Scholar 

  2. Juhasz-Boss I, Solomayer E, Strik M, Raspe C (2014) Abdominal surgery in pregnancy – an interdisciplinary challenge. Dtsch Arztebl Int 111:465–472

    PubMed  PubMed Central  Google Scholar 

  3. Penas-Herrero I, Serna-Higuera C de la, Perez-Miranda M (2015) Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci 22:35–43

    Article  PubMed  Google Scholar 

  4. Lammert F, Neubrand MW, Bittner R, Feussner H, Greiner L, Hagenmuller F, Kiehne KH et al (2007) S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract. Z Gastroenterol 45:971–1001

    Article  CAS  PubMed  Google Scholar 

  5. Lammert F et al. (2016) S3-Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen (aktualisierte Version). Z Gastroenterol: in Vorbereitung

  6. Shabanzadeh DM, Sorensen LT, Jorgensen T (2016) A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology 150:156–167

    Article  PubMed  Google Scholar 

  7. Lee YS, Kang BK, Hwang IK, Kim J, Hwang JH (2015) Long-term outcomes of symptomatic gallbladder sludge. J Clin Gastroenterol 49:594–598

    Article  PubMed  Google Scholar 

  8. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/DRGOperationen.html. Zugegriffen am: 29.03.2016

  9. Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW et al (1994) Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 154:2573–2581

    Article  CAS  PubMed  Google Scholar 

  10. Giljaca V, Gurusamy KS, Takwoingi Y, Higgie D, Poropat G, Stimac D, Davidson BR (2015) Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev 2:CD011549

    PubMed  Google Scholar 

  11. Benjaminov F, Stein A, Lichtman G, Pomeranz I, Konikoff FM (2013) Consecutive versus separate sessions of endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for symptomatic choledocholithiasis. Surg Endosc 27:2117–2121

    Article  PubMed  PubMed Central  Google Scholar 

  12. Adams MA, Hosmer AE, Wamsteker EJ, Anderson MA, Elta GH, Kubiliun NM, Kwon RS et al (2015) Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: accuracy of existing guidelines and the impact of laboratory trends. Gastrointest Endosc 82:88–93

    Article  PubMed  Google Scholar 

  13. Fusaroli P, Lisotti A, Syguda A, D’Ercole MC, Maimone A, Fabbri C, Cennamo V et al (2016) Reliability of endoscopic ultrasound in predicting the number and size of common bile duct stones before endoscopic retrograde cholangiopancreatography. Dig Liver Dis 48:277–282

    Article  PubMed  Google Scholar 

  14. Colli A, Conte D, Valle SD, Sciola V, Fraquelli M (2012) Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Aliment Pharmacol Ther 35:1370–1378

    Article  CAS  PubMed  Google Scholar 

  15. Stallmach A, Hagel S, Bruns T, Pletz M, Eckmann C (2013) Empirical antibiotic therapy in intra-abdomial infections: cases and evidence-based therapeutic recommendations. Z Gastroenterol 51:1069–1081

    Article  CAS  PubMed  Google Scholar 

  16. Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS, Chole SSG, West Midlands Research Collaborative (2016) Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg 103:27–34

    Article  CAS  PubMed  Google Scholar 

  17. Gillen S, Michalski CW, Schuster T, Feith M, Friess H, Kleeff J (2010) Simultaneous/Incidental cholecystectomy during gastric/esophageal resection: systematic analysis of risks and benefits. World J Surg 34:1008–1014

    Article  PubMed  Google Scholar 

  18. Gutt CN, Encke J, Koninger J, Harnoss JC, Weigand K, Kipfmuller K, Schunter O et al (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 258:385–393

    Article  PubMed  Google Scholar 

  19. Zafar SN, Obirieze A, Adesibikan B, Cornwell EE 3rd, Fullum TM, Tran DD (2015) Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 150:129–136

    Article  PubMed  Google Scholar 

  20. Sodergren MH, Markar S, Pucher PH, Badran IA, Jiao LR, Darzi A (2015) Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis. Surg Endosc 29:2077–2090

    Article  PubMed  Google Scholar 

  21. Lirici MM, Tierno SM, Ponzano C (2016) Single-incision laparoscopic cholecystectomy: does it work? A systematic review. Surg Endosc doi:10.1007/s00464-016-4757-5

    PubMed  Google Scholar 

  22. Yang TF, Guo L, Wang Q (2014) Evaluation of preoperative risk factor for converting laparoscopic to open cholecystectomy: a meta-analysis. Hepatogastroenterology 61:958–965

    PubMed  Google Scholar 

  23. Velanovich V, Morton JM, McDonald M, Orlando R 3rd, Maupin G, Traverso LW, Committee SO (2006) Analysis of the SAGES outcomes initiative cholecystectomy registry. Surg Endosc 20:43–50

    Article  CAS  PubMed  Google Scholar 

  24. Förster S, Reimer T, Rimbach S, Louwen F, Volk T, Burkle H, Benecke C et al (2015) CAMIC recommendations for surgical laparoscopy in non-obstetric Indications during pregnancy. Zentralbl Chir Jul 23 [Epub ahead of print]. doi:10.1055/s-0035-1545904

    Google Scholar 

  25. Nasioudis D, Tsilimigras D, Economopoulos KP (2016) Laparoscopic cholecystectomy during pregnancy: a systematic review of 590 patients. Int J Surg 27:165–175

    Article  PubMed  Google Scholar 

  26. Huttl TP, Hrdina C, Kramling HJ, Schildberg FW, Meyer G (2001) Gallstone surgery in German university hospitals. Development, complications and changing strategies. Langenbecks Arch Surg 386:410–417

    Article  CAS  PubMed  Google Scholar 

  27. Keus F, Jong JA de, Gooszen HG, Laarhoven CJ van (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 4:CD006231

    PubMed  Google Scholar 

  28. Moller M, Gustafsson U, Rasmussen F, Persson G, Thorell A (2014) Natural course vs interventions to clear common bile duct stones: data from the Swedish registry for gallstone surgery and endoscopic retrograde cholangiopancreatography (GallRiks). JAMA Surg 149:1008–1013

    Article  PubMed  Google Scholar 

  29. Saharia PC, Zuidema GD, Cameron JL (1977) Primary common duct stones. Ann Surg 185:598–604

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Denzer U, Beilenhoff U, Eickhoff A, Faiss S, Huttl P, Smitten SI, Jakobs R, Jenssen C et al (2015) S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022. Z Gastroenterol 53:E1–E227

    Article  CAS  PubMed  Google Scholar 

  31. Fusaroli P, Jenssen C, Hocke M, Burmester E, Buscarini E, Havre RF, Ignee A et al (2015) EFSUMB guidelines on interventional ultrasound (INVUS), part V. Ultraschall Med doi:10.1055/s-0035-1553738

    Google Scholar 

  32. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T et al (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12:CD003327

    PubMed  Google Scholar 

  33. Schiphorst AH, Besselink MG, Boerma D, Timmer R, Wiezer MJ, Erpecum KJ van, Broeders IA et al (2008) Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones. Surg Endosc 22:2046–2050

    Article  PubMed  Google Scholar 

  34. Reinders JS, Goud A, Timmer R, Kruyt PM, Witteman BJ, Smakman N, Breumelhof R et al (2010) Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis. Gastroenterology 138:2315–2320

    Article  PubMed  Google Scholar 

  35. Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA (2015) Meta-analysis of early endoscopic retrograde cholangiopancreatography (ERCP) +/− endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP). Surg Laparosc Endosc Percutan Tech 25:185–203

    Article  PubMed  Google Scholar 

  36. Lisi S de, Leandro G, Buscarini E (2011) Endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis: a systematic review. Eur J Gastroenterol Hepatol 23:367–374

    Article  PubMed  Google Scholar 

  37. Baal MC van, Besselink MG, Bakker OJ, Santvoort HC van, Schaapherder AF, Nieuwenhuijs VB, Gooszen HG et al (2012) Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg 255:860–866

    Article  PubMed  Google Scholar 

  38. daCosta DW, Bouwense SA, Schepers NJ, Besslink MG, van Santvoort HC, van Brunschott S, Bakker OJ et al (2015) Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicenter randomised controll trial. Lancet 386:1261–8

  39. Madhoun MF, Wani S, Hong S, Tierney WM, Maple JT (2014) Endoscopic papillary large balloon dilation reduces the need for mechanical lithotripsy in patients with large bile duct stones: a systematic review and meta-analysis. Diagn Ther Endosc 2014:1–8. doi:10.1155/2014/309618

    Article  Google Scholar 

  40. Dietrich CF, Lorentzen T, Appelbaum L, Buscarini E, Cantisani V, Correas JM, Cui XW et al (2016) EFSUMB guidelines on Interventional ultrasound (INVUS), part III – abdominal treatment procedures (long version). Ultraschall Med 37:E1–E32

    Article  CAS  PubMed  Google Scholar 

  41. Jang JW, Lee SS, Song TJ, Hyun YS, Park DH, Seo DW, Lee SK et al (2012) Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology 142:805–811

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Prötzeler Chaussee 5, 15341, Strausberg, Deutschland

    C. Jenssen

  2. Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Märkisch Oderland GmbH, Prötzeler Chaussee 5, Strausberg, 15341, Deutschland

    G. Bauer

Authors
  1. C. Jenssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Jenssen.

Ethics declarations

Interessenkonflikt

C. Jenssen und G. Bauer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

R. Jakobs, Ludwigshafen

F. Lammert, Homburg

C. Jenssen ist Mitglied der Expertengruppe zur Ausarbeitung der neuen S3-Leitlinie zum Thema Gallensteinleiden.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jenssen, C., Bauer, G. Choledocho- und Cholezystolithiasis. Gastroenterologe 11, 283–294 (2016). https://doi.org/10.1007/s11377-016-0082-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-016-0082-8

Schlüsselwörter

Keywords

Search

Navigation