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The Management of Biliary Disease in Patients with Severe Obesity Undergoing Metabolic and Bariatric Surgery—An International Expert Survey

  • 期刊论文

  • 发表日期：

    2024年2月24日

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  • Mohammad Kermansaravi,
  • Scott Shikora,
  • Bruno Dillemans,
  • Marina Kurian,
  • Teresa LaMasters,
  • Ramon Vilallonga,
  • Gerhard Prager,
  • Sonja Chiappetta,
  • Edo Aaarts,
  • Imran Abbas,
  • Ebrahim Aghajani,
  • Luigi Angrisani,
  • Luciano Antozzi,
  • Jan Apers,
  • Tanseer Asghar,
  • Ahmad Bashir,
  • Estuardo Behrens,
  • Helmuth Billy,
  • Daniel Caina,
  • Miguel‑A. Carbajo,
  • Benjamin Clapp,
  • Ricardo Cohen,
  • Jerome Dargent,
  • Amirhossein Davarpanah Jazi,
  • Maurizio De Luca,
  • Mohamad Hayssam ElFawal,
  • Daniel Moritz Felsenreich,
  • Michael Gagner,
  • Pierre Garneau,
  • Khaled Gawdat,
  • Tikfu GEE,
  • Omar M Ghanem,
  • Bijan Ghavami,
  • Saber Ghiassi,
  • Tamer A. A. M. Habeeb,
  • Ashraf Haddad,
  • Miguel F. Herrera,
  • Farah Husain,
  • Kazunori Kasama,
  • Radwan Kassir,
  • Nesreen Khidir,
  • Mousa Khoursheed,
  • Haris Khwaja,
  • Lillian Kow,
  • Jon Kristinsson,
  • Matthew Kroh,
  • Kuldeepak Singh Kular,
  • Panagiotis Lainas,
  • Laurant Layani,
  • Ken Loi,
  • Kamal Mahawar,
  • Tarek Mahdy,
  • John Melissas,
  • Karl Miller,
  • Hazem Almomani,
  • Mario Musella,
  • Alexandr Neimark,
  • Abdelrahman Nimeri,
  • Patrick Noel,
  • Taryel Omarov,
  • Mariano Palermo,
  • Chetan Parmar,
  • Abdolreza Pazouki,
  • Ralph Peterli,
  • Tadeja Pintar,
  • Tigran Poghosyan,
  • Jaime Ponce,
  • Dimitri Pournaras,
  • Arun Prasad,
  • Aayad Alqahtani,
  • Almino Ramos,
  • Masoud Rezvani,
  • Karl Rheinwalt,
  • Rui Ribeiro,
  • Elena Ruiz-Ucar,
  • Bassem Safadi,
  • Nasser Sakran,
  • Alaa Sewafy,
  • Asim Shabbir,
  • Shahab Shahabi Shahmiri,
  • Erik Stenberg,
  • Halit Eren Taskin,
  • Antonio Torres,
  • Cunchuan Wang,
  • Sylvia Weiner,
  • Wah Yang,
  • Natan Zundel

摘要

Objective

This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate the management of biliary disease in patients with severe obesity undergoing MBS.

Background

Obesity and rapid weight loss after MBS are risk factors for the development of gallstones. Complications, such as cholecystitis, acute cholangitis, and biliary pancreatitis, are potentially life-threatening, and no guidelines for the proper management of gallstone disease exist.

Methods

An international scientific team designed an online confidential questionnaire with 26 multiple-choice questions. The survey was answered by 86 invited experts (from 38 different countries), who participated from August 1, 2023, to September 9, 2023.

Results

Two-thirds of experts (67.4%) perform concomitant cholecystectomy in symptomatic gallstones during MBS. Half of experts (50%) would wait 6–12 weeks between both surgeries with an interval approach. Approximately 57% of the experts prescribe ursodeoxycholic acid (UDCA) prophylactically after MBS, and most recommend a 6-month course. More than the half of the experts (59.3%/53.5%) preferred laparoscopic assisted transgastric ERCP as the approach for treating CBD stones in patients who previously had RYGB/OAGB.

Conclusion

Concomitant cholecystectomy is preferred by the experts, although evidence in the literature reports an increased complication rate. Prophylactic UDCA should be recommended to every MBS patient, even though the current survey demonstrated that not all experts are recommending it. The preferred approach for treating common bile duct stones is a laparoscopic assisted transgastric ERCP after gastric bypass. The conflicting responses will need more scientific work and clarity in the future.

Graphical Abstract