From the Guidelines
The passing of stones in cholecystitis occurs in approximately 20-40% of patients with gallstones, with 10-15% of cases presenting as acute calculus cholecystitis. This condition is a significant concern as it can lead to complications such as biliary obstruction, pancreatitis, or cholangitis. The management of patients with suspected stone passage typically involves endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones, followed by cholecystectomy to prevent recurrence, as recommended by the 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis 1. Some key points to consider in the management of cholecystitis include:
- The estimated overall prevalence of gallstones is 10–15% in the general population 1
- Between 20 and 40% of patients with gallstones will develop gallstone-related complications, with an incidence of 1–3% annually 1
- Acute calculus cholecystitis (ACC) is the first clinical presentation in 10–15% of the cases 1
- Cholecystectomy is the most common therapeutic approach for ACC and is considered the standard of care for gallstone disease for the majority of patients 1. Early identification of stone passage is crucial as it may alter the treatment approach for cholecystitis, and a combined approach of ERCP and cholecystectomy is often necessary to prevent recurrence and manage complications.
From the Research
Passing of Stone in Cholecystitis
- The passing of a stone in cholecystitis is not directly addressed in the provided studies, however, the studies discuss the management and treatment of acute cholecystitis, which is often caused by gallstone obstruction of the cystic duct 2.
- Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis, suggesting that the passing of a stone is a common occurrence in this condition 2.
- The studies focus on the treatment and management of acute cholecystitis, including cholecystectomy, percutaneous cholecystostomy, and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) 3, 2, 4.
- There is no specific percentage mentioned in the studies regarding the passing of a stone in cholecystitis, as the studies primarily focus on the treatment and management of the condition rather than the specific details of stone passage.
Treatment and Management of Acute Cholecystitis
- Cholecystectomy is the gold standard treatment modality for acute cholecystitis, and early laparoscopic cholecystectomy is recommended for most patients 2, 4.
- Percutaneous cholecystostomy is an effective therapy for patients with an exceptionally high perioperative risk, but it is associated with higher rates of postprocedural complications compared to laparoscopic cholecystectomy 2.
- EUS-GBD with lumen-apposing metal stent (LAMS) is recommended as a therapy for never-surgical candidates with calculous acute cholecystitis, if they are eligible for monitored anesthesia care or general anesthesia and there is institutional expertise and minimal intervening ascites 3.