Abstract
Octogenarian and nonagenarian subjects with incidentally detected uncomplicated or symptomatic small gall stones may be treated without adverse outcomes of septicaemia and perforation with oral ursodeoxycholic avoiding surgery. Ninety-six subjects—64 men, 32 women, age > 65, with symptoms of acute or chronic cholecystitis having small gallstones < 15 mm or biliary sludge, high surgical risk of American Society of Anaesthesiologists (ASA) 3–4—were given 12–15 mg/kg/day ursodeoxycholic acid for 12–18 months. Clinical monitoring with liver function testing and ultrasonographic evaluation at 3 monthly interval and magnetic cholangiopancreatography per 6 months were done. Outcomes were evaluated in this cross sectional study. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase(ALP) values decreased significantly. Clinical, ultrasonographic and magnetic cholangiopancreatography evaluation at regular intervals showed improvement in all subjects which was not statistically significant. Fifty percent of gallstones smaller than 5–10 mm, 70% of stones smaller than 5 mm and bile sludge were successfully dissolved in all subjects. The success rate in patients with stones larger than 10 mm or multiple stones was low (8–10%). There were no severe side effects except mild diarrhoea, and 4% of patients underwent surgery and endoscopic retrograde cholangiopancreatography during the period of this study. Ursodeoxycholic acid medical treatment may be an alternative to cholecystectomy in octogenarian and nonagenarian subjects with incidentally detected uncomplicated or symptomatic small gallstones or those who refuse surgery.
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References
Kowddley KV (2000) Ursodeoxycholic acid therapy in hepatobiliary disease. Am J Med 108:481–486
Sauerbruch T (2002) Guidelines of the German Society of Gastroenterology for the treatment of gallstones. Z ArztlFortbildQualitatssich 96:222–226
Makino I, Tanaka H (1998) From a choleretic to an immunomodulator: historical review of ursodeoxycholic acid as a medicament. J Gastroenterol Hepatol 13(6):659–664
Portincasa P, Ciaula AD, Bonfrate L, Wang DQ (2012) Therapy of gallstone disease: what it was, what it is, what it will be. World J GastrointestPharmacolTher 3:7–20
Roma MG, Toledo FD, Boaglio AC, Basiglio CL, Crocenzi FA, Sánchez Pozzi EJ (2011) Ursodeoxycholic acid in cholestasis: linking action mechanisms to therapeutic applications. Clin Sci (Lond) 121:523–544
Venneman NG, Besselink MG, Keulemans YC, Vanberge-Henegouwen GP, Boermeester MA, Broeders IA, Go PM, van Erpecum KJ (2006) Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy. Hepatology 43:1276–1283
Pratt DS, Kaplan MM (2000) Evaluation of abnormal liver enzyme results in asymptomatic patients. N Engl J Med 342:1266–1271
Podda M, Zuin M, Dioguardi ML, Festorazzi S, Dioguardi N (1982) A combination of ursodeoxycholic acid and chenodeoxycholic acid is more effective than either alone in reducing biliary cholesterol saturation. Hepatology 2:334–339
Villanova N, Bazzoli F, Taroni F, Frabboni R, Mazzella G, Festi D et al (1989) Gallstone recurrence after successful oral bile acid treatment. A 12-year follow-up study and evaluation of long-term postdissolutiontreatment. Gastroenterology 97:726–731
Yamanouchi K, Azuma T, Taniguchi K, Inoue Y, Handa SK (2011) MatsuoFeasibility and problems in managing patients with acute cholecystitis: an historical study at a single provincial institute. Acta Med Nagasaki 56:69–72
Portincasa P, Moschetta A, Petruzzelli M, Palasciano G, Di Ciaula A, Pezzolla A (2006) Gallstone disease: symptoms and diagnosis of gallbladder stones. Best Pract Res Clin Gastroenterol 20:1017–1029
Lassini A, Facchinnatti D, Bettini L, Muissen G (1991) Best buy regimen of UDCA for patients with gallstones. J Gastroenterol 26:551–6
Sackmann M, Pauletzki J, Aydemir U et al (1991) Efficacy and safetyofursodeoxycholic acid for dissolution of gallstone fragments:comparison with the combination of ursodeoxycholic acid andchenodeoxycholic acid. Hepatology 14:1136–41
European Association for the Study of the Liver. Electronic address eee (2016) EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. JHepatol 65:146–81
Wang DQ, Portincasa P (eds) (2017) Gallstones. Recent advances in epidemiology, pathogenesis, diagnosis and management . 1 New York, NY: Nova Science Publisher Inc 1–676
Marsio L (1990) Treatment of cholesterol gallstone patients with UDCA. Gastroenterology 99(6):1769–85
Podda M, Zuin M, Battezzati PM, Ghezzi C, De Fazio C, Dioguardi ML (1989) Efficacy and safety of a combination of chenodeoxycholic and ursodeoxycholic acid for gallstone dissolution:a comparison with ursodeoxycholic acid alone. Gastroenterology 96:222–9
Neligan P, Bateson M, Tras DB, Rosso PE (1983) Ursodeoxycholic acid fort hedissulotion of radiolucent gall-bladder stones. Digestion 28(4):225–83
Cleeson D, Ruppin D, Saunders A, Murphy G (1990) Final outcome of UDCA treatment in 126 patients with radiolucent gallstone. QJ Med 279:711–729
Villanova N, Bazzoli F, Taroni F, Frabboni R, Mazzella G, Festi D, Barbara L, Roda (1989) Gallstone recurrence after successful oral bile acid treatment. A 12-year follow-up study and evaluation of long-term postdissolution treatment. Gastroenterology 97(3):726–31
(2016) Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 65:146–81
Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M (2013) Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol
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Doğan, Y., Oğullar, S. Medical Management of Uncomplicated Symptomatic Small Gallstones in Elderly. Indian J Surg (2023). https://doi.org/10.1007/s12262-023-03953-3
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DOI: https://doi.org/10.1007/s12262-023-03953-3