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. 2023 Jul 17:36:e1747.
doi: 10.1590/0102-672020230029e1747. eCollection 2023.

ASYMPTOMATIC CHOLELITHIASIS: EXPECTANT OR CHOLECYSTECTOMY. A SYSTEMATIC REVIEW

Jose Roberto Alves  1 , Diurlhane Mainara Klock  2 , Filipe Gonçalves Ronzani  2 , Sheyne Luiz Dos Santos  3 , Enio Campos Amico  4
Affiliations

ASYMPTOMATIC CHOLELITHIASIS: EXPECTANT OR CHOLECYSTECTOMY. A SYSTEMATIC REVIEW

Jose Roberto Alves et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Asymptomatic cholelithiasis is a highly prevalent disease, and became more evident after the currently greater access to imaging tests. Therefore, it is increasingly necessary to analyse the risks and benefits of performing a prophylactic cholecystectomy.

Aims: To seek the best evidence in order to indicate prophylactic cholecystectomy or conservative treatment (clinical follow-up) in patients with asymptomatic cholelithiasis.

Methods: A systematic review was performed using the PubMed/Medline database, according to PRISMA protocol guidelines. The review was based on studies published between April 26, 2001 and January 07, 2022, related to individuals older than 18 years., The following terms/operators were used for search standardization: (asymptomatic OR silent) AND (gallstones OR cholelithiasis).

Results: We selected 18 studies eligible for inference production after applying the inclusion and exclusion criteria. Also, the Tokyo Guideline (2018) was included for better clarification of some topics less or not addressed in these studies.

Conclusions: Most evidence point to the safety and feasibility of conservative treatment (clinical follow-up) of asymptomatic cholelithiasis. However, in post-cardiac transplant patients and those with biliary microlithiasis with low preoperative surgical risk, a prophylactic cholecystectomy is recommended. To establish these recommendations, more studies with better levels of evidence must be conducted.

RACIONAL:: A colelitíase assintomática é uma doença altamente prevalente, e atualmente tornou-se mais evidente, após o maior acesso a exames de imagem. Portanto, é cada vez mais necessário analisar os riscos e benefícios de realizar uma colecistectomia profilática.

OBJETIVOS:: Buscar as melhores evidências para indicar colecistectomia profilática ou tratamento conservador (acompanhamento clínico) em pacientes com colelitíase assintomática.

MÉTODOS:: Foi realizada revisão sistemática, no PubMed/Medline, de acordo com as diretrizes do protocolo PRISMA, selecionando estudos publicados entre 26/04/2001 e 01/07/2022, relacionados a indivíduos maiores de 18 anos, com padronização de busca usando os seguintes termos/operadores: (Assintomático OU Silencioso) E (Cálculos biliares OU colelitíase).

RESULTADOS:: Foram selecionados 18 estudos elegíveis após a aplicação dos critérios de inclusão e exclusão. Além disso, a Tokyo Guideline (2018) foi incluída para melhor esclarecimento de alguns tópicos menos ou não abordados nestes estudos.

CONCLUSÕES:: A maioria das evidências aponta para a segurança e viabilidade do tratamento conservador (acompanhamento clínico) da colelitíase assintomática. Entretanto, em pacientes com transplante pós-cardíaco e aqueles com microlitíase biliar com baixo risco cirúrgico pré-operatório, a colecistectomia profilática é recomendada. Para estabelecer completamente estas recomendações, mais estudos com melhores níveis de evidência devem ser conduzidos.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Flowchart demonstrating the systematization and selection of eligible studies for inference production.
See this image and copyright information in PMC

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References

    1. Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, et al. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial) BMJ Open. 2021;11(3):e039781. doi: 10.1136/bmjopen-2020-039781. - DOI - PMC - PubMed
    1. Bencini L, Marchet A, Alfieri S, Rosa F, Verlato G, Marrelli D, et al. The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer-a randomized-controlled trial. Gastric Cancer. 2019;22(3):632–639. doi: 10.1007/s10120-018-0879-x. - DOI - PubMed
    1. Brasca A, Berli D, Pezzotto SM, Gianguzza MP, Villavicencio R, Fray O, et al. Morphological and demographic associations of biliary symptoms in subjects with gallstones: findings from a population-based survey in Rosario, Argentina. Dig Liver Dis. 2002;34(8):577–581. doi: 10.1016/s1590-8658(02)80091-3. - DOI - PubMed
    1. Choi SY, Kim TS, Kim HJ, Park JH, Park DI, Cho YK, et al. Is it necessary to peorm prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones? J Gastroenterol Hepatol. 2010;25(6):1099–1104. doi: 10.1111/j.1440-1746.2010.06288.x. - DOI - PubMed
    1. Elmagarmid A, Fedorowicz Z, Hammady H, Ilyas I, Khabsa M, Ouzzani M. Rayyan: a systematic reviews web app for exploring and filtering searches for eligible studies for Cochrane Reviews. InEvidence-Informed Public Health: Opportunities and Challenges. Abstracts of the 22nd Cochrane Colloquium. Hyderabad: John Wiley & Sons; 2014. pp. 21–26.

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