Procedure Provided No Relief After Gallbladder Removal

Gallbladder surgery patients did not appear to benefit from endoscopic procedure after surgery

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Gallbladder problems may be treated by removing the organ, but that can lead to abdominal pain. To relieve pain, doctors may use an endoscopic procedure, but its benefits are questionable.

The gallbladder is a small pear-shaped organ that stores bile made by the liver and releases it through a duct into the small intestine. When people experience severe troubles related to the gallbladder, removal (cholecystectomy) is an option.

About one in 10 patients who have this procedure experience abdominal pain. While doctors may investigate this pain using an endoscope (small tube with light and camera at the end) and perform additional surgery, new research has found that this approach may not reduce the number of days of disability due to pain related to gallbladder surgery.

"Cut calories and eat healthy to lower gallbladder disease risk."

Peter B. Cotton, MD, professor of medicine in the Division of Gastroenterology and Hepatology at the Medical University of South Carolina in Charleston, and colleagues studied 214 patients who had pain following cholecystectomy.

Scientists estimate that more than 700,000 gallbladder removals are performed each year in the US, and 10 percent lead to severe abdominal pain.

To examine pancreatic and bile ducts that may have small stones or other problems that may trigger this pain, doctors may use a small bendable tube called an endoscope. With a procedure called endoscopic retrograde cholangiopancreatography (ERCP), an endoscope is passed through the mouth until it reaches the small intestine and then a catheter (a thinner tube) is fed through the endoscope to reach the ducts.

Based on the endoscope results, doctors may determine that the patient needs a sphincterotomy of the bile or pancreatic ducts. A sphincterotomy is a surgery used to allow substances to more easily pass through sphincter muscles, which are muscles that contract to close various openings throughout the body.

Dr. Cotton and his team questioned the value of endoscopic procedures, noting that the procedure may increase rates of pancreatitis and perforations (holes). They also presented background information tying endoscopic procedures to extended hospital stays and some deaths.

In this study, 141 patients had sphincterotomy and 71 had “sham” (placebo) therapy, meaning they did not actually have a procedure after gall bladder removal.

Patients were evaluated at 12 months after the sphincterotomy or placebo treatment, and success was measured as having fewer than six days of disability due to pain prior to the evaluation.

At 12 months, 37 percent of the sham group had success, while 23 percent in the sphincterotomy group had success.

“These findings do not support the use of ERCP and sphincterotomy for these patients,” the authors wrote. “The finding that endoscopic sphincterotomy is not an effective treatment has major implications for clinical practice because it applies to many thousands of patients.”

To prevent gallbladder disease, diets containing fiber, vegetable protein, nuts, calcium, vitamin C and coffee, along with physical activity, may offer protective effects, according to previously published research in Best Practice & Research Clinical Gastroenterology.

The study was published in the May 28 issue of JAMA. The research was funded by a grant from the National Institutes of Diabetes and Digestive and Kidney Diseases.

Review Date: 
May 27, 2014
Last Updated:
May 31, 2014