Treatment of common bile duct stones in Sweden 1989-2006: an observational nationwide study of a paradigm shift.

摘要

Once again, the power of a national register to examine trends in patient management over time has been well demonstrated in this paper. The big difficulty in such a study is to see into the results and unravel the management decisions of why individual patients received the treatment they did. Perhaps the most striking change during the time period (apart from the trend in open to laparoscopic cholecystec-tomy, which has been observed worldwide) has been the halving (from 60 to 31.1 %) of cholecystectomy performed at the index admission. Disappointingly, the authors offer little explanation for this [1]. The change is too great to be explained fully by an aging population with endoscopic sphincterotomy as definitive treatment of gallstones.