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Gastroenterologie up2date 2019; 15(03): 235-255
DOI: 10.1055/a-0779-4137
Leber/Galle/Pankreas
Georg Thieme Verlag KG Stuttgart · New York

Gallensteinerkrankungen

Frank Lammert
,
Carsten Gutt
Further Information

Publication History

Publication Date:
17 September 2019 (online)

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Update of:

Gallensteinerkrankungen – Update 2015Gastroenterologie up2date 2015; 11(04): 261-281
DOI: 10.1055/s-0034-1393402

Gallensteine sind häufig. Bezogen auf ihre hohe Prävalenz führen sie selten zu letal verlaufenden Krankheitsbildern, chronischen Erkrankungen oder Komplikationen. Dies gilt vor allem für Gallenblasensteine. Allerdings verursachen sie als eine der häufigsten Ursachen für Operationen hohe Kosten im Gesundheitswesen. Dieser Beitrag widmet sich der Pathogenese, Diagnostik und aktuellen Therapie von Gallensteinerkrankungen und ihren Komplikationen.
Kernaussagen

  • Regelmäßige körperliche Aktivität und bedarfsgerechte Ernährung zur Erhaltung eines möglichst normalen Körpergewichts können der Entwicklung von Cholesteringallenblasensteinen und biliären Symptomen vorbeugen.

  • Die asymptomatische Cholezystolithiasis soll in der Regel nicht operativ behandelt werden.

  • Nur 60% der Patienten sind nach einer Cholezystektomie wegen als steinbedingt angesehener Symptome beschwerdefrei.

  • Die akute Cholezystitis ist eine Indikation zur frühzeitigen laparoskopischen Cholezystektomie; diese sollte innerhalb von 24 h nach stationärer Aufnahme erfolgen.

  • Die Standardtherapie der simultanen Cholezysto- und Choledocholithiasis ist die präoperative ERC mit EPT, gefolgt von der laparoskopischen Cholezystektomie.

  • Nach erfolgreicher endoskopischer Gallengangsanierung sollte bei Cholezystolithiasis möglichst innerhalb von 72 h cholezystektomiert werden.

  • Nach einer milden biliären Pankreatitis (keine Nekrosen, CRP < 100 mg/l) soll die Cholezystektomie so bald wie möglich erfolgen.

Schlüsselwörter

Cholezystolithiasis - Choledocholithiasis - Cholezystitis - Cholangitis - biliäre Pankreatitis
 

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