Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligos...

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Autores principales:	V.I. Kolomiytsev, O.V. Lukavetskiy, O.M. Terletskiy
Formato:	article
Lenguaje:	EN UK
Publicado:	Danylo Halytsky Lviv National Medical University 2020
Materias:	acute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/4aafc9547df4404ea34de3bfa93f588f
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spelling	oai:doaj.org-article:4aafc9547df4404ea34de3bfa93f588f2021-11-10T19:49:51ZAspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis1029-42442415-330310.25040/aml2020.02-03.049https://doaj.org/article/4aafc9547df4404ea34de3bfa93f588f2020-09-01T00:00:00Zhttps://amljournal.com/index.php/journal/article/view/24https://doaj.org/toc/1029-4244https://doaj.org/toc/2415-3303Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis were analyzed, 166 of which-were studied retrospectively, and 49 - prospectively. Female patients predominated (74.0%); the average age was 56.0±1.06 years. Blood serum biochemistry, transabdominal ultrasound, magnetic resonance cholangiopancreatography, and blood and bile microRNA were used for the diagnosis. Results and Discussion. After verification of the diagnosis by applying several tests and developed multivariate models based on determining the blood and bile microRNA, and the model consisting of 5 factors for the prediction of the presence of choledocholithiasis (alkaline phosphatase, AST, ALT, total bilirubin, the common bile duct diameter according to transabdominal ultrasound), the main therapeutic option to resolve biliary duct problems in 183 (85.1%) patients were endoscopic retrograde cholangiography (ERC) with sphincterotomy and stone extraction. In the second step, 159 (74.0%) patients underwent laparoscopic cholecystectomy. One-step interventions (laparoscopic cholecystectomy and stones removal / intraoperative therapeutic ERC) due to association with acute cholecystitis changes in the hepatoduodenal ligament were performed on 7 (3.3%) patients only. Conclusions. In patients with acute calculous cholecystitis, using a 5-factor model has a fairly high prognostic value for the prediction of choledocholithiasis, and the additional use of quantifying the expression levels of miRNA-122 and miRNA-21 significantly improves the diagnosis of asymptomatic choledocholithiasis. The optimal approach to the treatment of such patients is to perform therapeutic ERCP followed by laparoscopic cholecystectomy.V.I. KolomiytsevO.V. LukavetskiyO.M. TerletskiyDanylo Halytsky Lviv National Medical Universityarticleacute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomyMedicine (General)R5-920ENUKActa Medica Leopoliensia, Vol 26, Iss 2-3, Pp 49-54 (2020)
institution	DOAJ
collection	DOAJ
language	EN UK
topic	acute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy Medicine (General) R5-920
spellingShingle	acute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy Medicine (General) R5-920 V.I. Kolomiytsev O.V. Lukavetskiy O.M. Terletskiy Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
description	Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis were analyzed, 166 of which-were studied retrospectively, and 49 - prospectively. Female patients predominated (74.0%); the average age was 56.0±1.06 years. Blood serum biochemistry, transabdominal ultrasound, magnetic resonance cholangiopancreatography, and blood and bile microRNA were used for the diagnosis. Results and Discussion. After verification of the diagnosis by applying several tests and developed multivariate models based on determining the blood and bile microRNA, and the model consisting of 5 factors for the prediction of the presence of choledocholithiasis (alkaline phosphatase, AST, ALT, total bilirubin, the common bile duct diameter according to transabdominal ultrasound), the main therapeutic option to resolve biliary duct problems in 183 (85.1%) patients were endoscopic retrograde cholangiography (ERC) with sphincterotomy and stone extraction. In the second step, 159 (74.0%) patients underwent laparoscopic cholecystectomy. One-step interventions (laparoscopic cholecystectomy and stones removal / intraoperative therapeutic ERC) due to association with acute cholecystitis changes in the hepatoduodenal ligament were performed on 7 (3.3%) patients only. Conclusions. In patients with acute calculous cholecystitis, using a 5-factor model has a fairly high prognostic value for the prediction of choledocholithiasis, and the additional use of quantifying the expression levels of miRNA-122 and miRNA-21 significantly improves the diagnosis of asymptomatic choledocholithiasis. The optimal approach to the treatment of such patients is to perform therapeutic ERCP followed by laparoscopic cholecystectomy.
format	article
author	V.I. Kolomiytsev O.V. Lukavetskiy O.M. Terletskiy
author_facet	V.I. Kolomiytsev O.V. Lukavetskiy O.M. Terletskiy
author_sort	V.I. Kolomiytsev
title	Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
title_short	Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
title_full	Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
title_fullStr	Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
title_full_unstemmed	Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
title_sort	aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
publisher	Danylo Halytsky Lviv National Medical University
publishDate	2020
url	https://doaj.org/article/4aafc9547df4404ea34de3bfa93f588f
work_keys_str_mv	AT vikolomiytsev aspectsofdiagnosisandtreatmentofoligosymptomaticcholedocholithiasisinpatientswithacutecalculouscholecystitis AT ovlukavetskiy aspectsofdiagnosisandtreatmentofoligosymptomaticcholedocholithiasisinpatientswithacutecalculouscholecystitis AT omterletskiy aspectsofdiagnosisandtreatmentofoligosymptomaticcholedocholithiasisinpatientswithacutecalculouscholecystitis
_version_	1718439772808019968

Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

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