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Gallensteine

Von der molekularen Pathogenese zur leitlinienbasierten Prävention und Therapie

Gallstones

From molecular pathogenesis to guideline-based prevention and therapy

Der Gastroenterologe volume 2, pages 461–476 (2007)Cite this article

Zusammenfassung

15–20% der deutschen Bevölkerung haben Gallensteine, und jährlich werden in Deutschland mehr als 190.000 Cholezystektomien wegen symptomatischer Gallensteine durchgeführt. 90% sind Cholesterinsteine, die infolge einer vermehrten Cholesterinsekretion der Leber in einer hypomotilen Gallenblase entstehen. Die Cholesterinhypersekretion wird auf exogene Faktoren (z. B. hochkalorische, kohlenhydratreiche Ernährung und Bewegungsmangel) und genetische Risikofaktoren (z. B. Genvariante des hepatischen Cholesterintransporters ABCG5/G8) zurückgeführt. Pro Jahr entwickeln 1–3% der Steinträger Koliken; die Komplikationsrate (Cholezystitis, Cholangitis, Pankreatitis) liegt um den Faktor 10 niedriger. Die laparoskopische Cholezystektomie ist sowohl bei unkomplizierter Cholezystolithiasis als auch bei der akuten Cholezystitis die Therapie der Wahl. Sie führt bei identischen Komplikationsraten zu kürzeren Krankenhausverweil- und Rekonvaleszenzzeiten. Die vor Kurzem aktualisierte S3-Leitlinie zur Diagnose und Therapie von Gallensteinen empfiehlt bei gleichzeitig bestehender Choledocholithiasis das therapeutische Splitting mit präoperativer ERC und Steinextraktion; bei zweifelhaftem Befund sollten Endosonographie –alternativ eine Magnetresonzcholangiographie – vorgeschaltet werden.

Abstract

In Germany, 15–20% of individuals develop gallstones, and more than 190,000 cholecystectomies are performed for symptomatic stones annually. Overall, 90% of gallstones are cholesterol stones, which are due to increased hepatic cholesterol secretion and gallbladder hypomotility. Cholesterol hypersecretion is attributed to exogenous risk factors, such as a hypercaloric carbohydrate-rich diet and physical inactivity, as well as to lithogenic genes, such as common gene variants of the hepatic cholesterol transporter ABCG5/G8. Of stone carriers, 1–3% per year develop symptoms (biliary colic), and the rate of complications (cholecystitis, cholangitis, pancreatitis) ranges from 0.1% to 0.3% per year. Today laparoscopic cholecystectomy represents the standard of care for most symptomatic stones with and without complications because it leads to shorter hospital stays and recovery times than open cholecystectomy but has similar complication rates. The recently updated German S3 guidelines for diagnosis and treatment of gallstones recommends preoperative endoscopic retrograde cholangiography and stone extraction in cases of simultaneous bile duct and gallbladder stones; if the probability of bile duct stones is moderate, endoscopic ultrasound – or magnetic resonance cholangiography – should precede cholecystectomy.

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  1. Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    F. Lammert & T. Sauerbruch

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  1. F. Lammert
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  2. T. Sauerbruch
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Correspondence to F. Lammert.

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Lammert, F., Sauerbruch, T. Gallensteine. Gastroenterologe 2, 461–476 (2007). https://doi.org/10.1007/s11377-007-0119-0

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