Management of gallstones in diabetic patients
J. N. Aucott, G. S. Cooper, A. D. Bloom and D. C. Aron
Department of Medicine, Cleveland Veterans Affairs Medical Center, Ohio.
The management of gallstones in diabetic patients has traditionally been
considered problematic. Autopsy findings and uncontrolled studies have
documented a higher prevalence of cholelithiasis in diabetics, and early
reports showed dramatically increased perioperative morbidity and mortality
for treatment of diabetics with acute cholecystitis. As a result, some
authorities have recommended prophylactic cholecystectomy for diabetic
patients with asymptomatic gallstones, which is in contrast to
recommendations for nondiabetics. More recent investigators have shown
comparable rates of operative morbidity and mortality for biliary surgery
in diabetics when compared with the general population. Recent studies have
questioned whether diabetes is an independent risk factor for gallstone
formation. Decision analyses using these new data have shown that
prophylactic cholecystectomy is not of clear benefit and should not be
routinely recommended for diabetics with asymptomatic gallstones. We
believe that available data, although limited, indicate that asymptomatic
patients with diabetes do not benefit from screening for gallstones and
that cholecystectomy should only be performed in cases of symptomatic
cholelithiasis, as is the case in the general population.
