Registry codes: BIL · converted from the registry dossier families/14-gallbladder-biliary.md — the dossier remains the source of truth; this page is its reading surface.
35 cards · 🟢 23 verified · 🟡 6 qualified · 🔴 5 disputed · ⚪ 1 qualitative — global registry: 41 disputed cards carry their dispute on the card.
🟢Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed
Japan–Taiwan multicentre validation cohort of acute cholecystitis
Variants the registry prints
Arabic short title: وفيات التهاب المرارة بالدرجة: ١٫١٪ / ٠٫٨٪ / ٥٫٤٪ (٣٠ يوم); Type: Mortality — red
Basis — n / evidence base
Multicentre cohort (validation study for the grading)
Evidence tier (the registry's wording)
Large multicentre validation — figures verified via the TG18 evidence summaries
Dispute — the sources disagree
Yokoe et al. — Japan–Taiwan validation (via TG18) · Grade I 1.1% · II 0.8% · III 5.4% (30-day) · All-comer multicentre cholecystitis cohort · 2017 · PMID 28419779
Second series quoted in TG18 materials · 0% · 0.5% · 18.0% · Surgical-series case-mix (operated patients; different era/country mix) · (TG18-era) · via TG18
Adopted
the validation cohort (BIL-AC-MORT-01, 🟢) as the population figure; the 18% is retained here — visible, explained — as the warning that within Grade III, trajectory (organ-dysfunction count, 3.1%→25%) matters more than the label.
BIL-AC-SUC-02 · Laparoscopic cholecystectomy vs percutaneous catheter drainage in high-risk patients
Major complications 12% (8/66) LC vs 65% (44/68) drainage · 3% vs 9% · 5 vs 9 days
(RR 0.19, 0.10–0.37). Death (P=0.27, NS). Median stay
Major complications = composite of infectious/cardiopulmonary complications ≤1 month, reintervention ≤1 year, recurrent biliary disease ≤1 year; death ≤1 year
(i) Complete dissolution: pooled 63% after >6 months' therapy · (ii) Long-term cure: only 27% · (iii) Recurrence after dissolution: 25–64% at 5 years; 49–80% at 10 years · Guideline position: litholysis NOT recommended
(EASL-carried meta-analysis). (EASL summary figure). ; complications on UDCA ~2%/yr — no better than untreated. (moderate quality evidence, strong recommendation)
(i) Complete dissolution of stones on UDCA, confirmed imaging, in strictly selected patients; (ii) long-term cure (stone-free and remaining so); (iii) recurrence after successful dissolution
🔴Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed
Selected: small (<5–10 mm), radiolucent (non-calcified) cholesterol stones, functioning gallbladder with patent cystic duct, mild symptoms only
Variants the registry prints
Arabic short title: تذويب أورسوديول: تذويب كامل ٦٣٪ مختارين، شفاء دائم ٢٧٪، رجوع حتى ٨٠٪ @١٠ سنوات — الحكم: مرفوض كما قيل; Type: Success — emerald
Basis — n / evidence base
MA + long-term cohorts
Evidence tier (the registry's wording)
Guideline — full text opened; the MA and cohorts are carried within it
Dispute — the sources disagree
Owner's 2023 video dictation · "Success <20%; 80% fail or recur after stopping" · Implied: gallstone patients generally · Unstated · — · 2023 · —
Meta-analysis carried in EASL · Complete dissolution 63% after >6 months · Strictly selected: small non-calcified stones, functioning GB · Complete stone disappearance on imaging · During therapy · (in EASL 2016) · PMID 27085810
EASL summary ("cure") · Long-term cure 27% · Same selected population · Stone-free and remaining cured · Long-term · 2016 · PMID 27085810
Recurrence cohorts (EASL) · Recurrence 25–64% @5y; 49–80% @10y · Patients *after successful dissolution* · Stone recurrence on surveillance · 5–10 years · (in EASL 2016) · PMID 27085810
Adopted
the three-layer figure set on BIL-ALT-DIS-01: 63% complete dissolution (selected, on therapy) · 27% long-term cure · recurrence up to ~80% at 10 years — with the guideline's own conclusion: litholysis not recommended. Verdict: ❌ REJECTED as stated; corrected figure set adopted. The patient's instinct behind the original claim (dissolution is a poor long-term bet) is upheld by the evidence; its arithmetic was not.
Stone-free ("cure"): 55% · Recurrence: >40% within 4 years · Guideline position: not a standard therapy
in carefully selected patients (EASL summary figure, same sentence as UDCA's 27%). after ESWL or complete dissolution. ; largely abandoned where laparoscopic surgery is available
Stone-free rate ("cure") after ESWL, usually with adjuvant UDCA, in carefully selected patients; and recurrence thereafter
🔴Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed
Selected: solitary radiolucent stone ≤20 mm (best results), functioning gallbladder; historic Munich-centred experience
Variants the registry prints
Arabic short title: تفتيت ESWL: ٥٥٪ خلوّ عند المختارين، رجوع >٤٠٪ @٤ سنوات — الحكم: مؤكد بشروطه; Type: Success — emerald
Basis — n / evidence base
Historic cohorts via guideline
Evidence tier (the registry's wording)
Guideline — full text opened
Dispute — the sources disagree
Owner's 2023 video dictation · "~50% success" · Implied: gallstone patients generally · Unstated · 2023 · —
EASL summary ("cure") · 55% stone-free · Carefully selected: solitary radiolucent stone ≤20 mm, functioning GB, adjuvant UDCA era cohorts · Stone-free after ESWL course · 2016 synthesis of historic cohorts · PMID 27085810
EASL recurrence data · >40% recurrence within 4 years · After ESWL or complete dissolution · Stone recurrence · 2016 · PMID 27085810
Adopted
55% in carefully selected patients, with >40% 4-year recurrence, not a standard therapy (BIL-ALT-DIS-02, 🔴). Verdict: ✅ CONFIRMED in substance — the figure stands, its conditions are now welded to it. Any future use of "~50%" without the selection conditions and the recurrence figure is a misuse of this card.
Andriulli et al. (SR, prospective studies) · 3.47% (3.19–3.75); severe 0.4%; fatal 0.11% · All ERCP patients in prospective series · Clinically detected PEP · 16,855 (21 studies) · 2007 · DOI 10.1111/j.1572-0241.2007.01279.x
Kochar et al. (SR, RCT control arms) · 9.7%; high-risk 14.7% · Control arms of RCTs · PEP per trial protocol (scheduled enzyme checks catch asymptomatic hyperenzymemia + mild cases) · 13,296 (108 RCTs) · 2015 · DOI 10.1016/j.gie.2014.06.045
Akshintala et al. (SR update) · 10.2% (9.3–11.3) · RCT arms · As above · 145 RCTs · 2023 · (SR; journal record verified)
Adopted
the clinical figure — ≈3.5 per 100 in unselected practice; up to ~15 per 100 in high-risk patients (BIL-CBD-COMP-01, 🔴 with both families of estimates shown). Trial designers should use ~10%; patients should be counselled with ~3.5% + their risk stratum.
BIL-CBD-SUC-01 · Successful duct clearance at ERCP
Benchmark: >90% clearance · Large stones (>10 mm): complete clearance at first ERCP 85%
of stones <1 cm (ASGE/ACG quality indicator, *target* not audit mean). with endoscopic papillary large-balloon dilation ± sphincterotomy (systematic review)
Complete stone extraction: the quality-indicator benchmark for extrahepatic stones <1 cm in normal anatomy (performance target), and SR figure for large stones
BIL-CTX-CAN-01 · Incidental gallbladder cancer in cholecystectomy specimens
Low-incidence countries: pooled 0.32% (95% CI 0.25–0.42) · High-incidence countries: 0.83% (0.58–1.18)
truly incidental 0.18%.
GBC first diagnosed on histopathology of a cholecystectomy specimen removed for presumed benign disease ("incidental"; "truly incidental" = no preoperative or intraoperative suspicion)
BIL-CTX-WL-01 · Gallstone formation during rapid weight loss
Placebo 32%
formed stones at 6 months — the baseline hazard that prophylaxis is measured against. (In EASL's synthesis, symptomatic stones after bariatric surgery occur in 10–15%.)
New gallstones on ultrasound at 6 months after gastric bypass without prophylaxis (placebo arm)
BIL-CTX-WL-01 · Gallstone formation during rapid weight loss
🟢Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed
Morbid obesity (BMI ≥40), gastric-bypass RCT
Variants the registry prints
Arabic short title: تكوّن حصوات مع النزول السريع: ٣٢٪ @٦ شهور بلا وقاية; Type: Prevalence — purple
Basis — n / evidence base
n=233 with postoperative sonograms
Evidence tier (the registry's wording)
RCT — abstract verified (1995; justified retention: the placebo-arm natural experiment cannot ethically be repeated, and it remains the cited baseline)
Farrugia: pooled 13.3% (462/3,476), study range 2.1–57.2% · Farahmandfar: 9.1% (302/3,306) · ~63.5% of PCD patients
. Within PCD, bile-acid diarrhoea is the dominant mechanism: (SeHCAT-based study carried in Farrugia); BAM in 65.5% of tested PCD (Farahmandfar); cholestyramine response 92% in the older review
New diarrhoea after cholecystectomy, definitions varying by study (questionnaire/interview/stool chart)
🔴Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed
Farrugia SR 2022: 21 studies · Farahmandfar SR 2012: 25 studies
Variants the registry prints
Arabic short title: إسهال ما بعد الاستئصال: المُعتمد للحوار ~١ من ١٠ (٩–١٣٪); Type: Complications — amber
Basis — n / evidence base
3,476 + 3,306 patients
Evidence tier (the registry's wording)
Two SRs — Farrugia full text opened; Farahmandfar abstract verified
Dispute — the sources disagree
Farrugia et al. (SR) · Pooled 13.3%; study range 2.1–57.2% · Post-cholecystectomy cohorts · New-onset diarrhoea — instruments from stool charts to QoL questionnaires, follow-up days→years · 3,476 (21 studies) · 2022 · PMID 35177439 (PMC8860059)
Farahmandfar et al. (SR) · 9.1% · Post-cholecystectomy cohorts · Change in bowel habit/diarrhoea post-op · 3,306 (25 studies) · 2012 · DOI 10.4236/ss.2012.36065
Adopted
counselling figure "about 1 in 10" (the two pooled estimates bracket it: 9.1–13.3%), with the mechanism rider — ~two-thirds of persistent PCD is bile-acid diarrhoea and is treatable (BIL-GB-COMP-05, 🔴). No single pooled percentage is headlined.
🟡Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed
Historical surgical/X-ray-era series vs modern ultrasound-era series
Variants the registry prints
Arabic short title: المرارة الخزفية: خطر السرطان بحسب نمط التكلس (انتقائي ~٧٪، كامل منخفض); Type: Context — blue
Evidence tier (the registry's wording)
Guideline — full text opened; the 20% is an era-bound figure and is never quoted without its era
Dispute — the sources disagree
Traditional teaching · Porcelain GB → operate (cancer risk "up to 25%"); stone >3 cm → operate · All carriers with the finding · Any wall calcification; any large stone · Pre-2000s series · —
EASL CPG 2016 · Porcelain: carcinoma in up to 20% of calcified GBs in X-ray-era series; selective/spotty calcification ~7%, complete homogeneous calcification very low; "may undergo cholecystectomy" — very low quality evidence, weak recommendation; CT confirmation advised. Large stone: case–control ORs (Diehl) against a baseline 20-year cancer risk of ~0.2–0.5% · Same findings, imaging-era stratification · Calcification pattern on CT; stone size bands · 2016 (Diehl 1983) · PMID 27085810 · DOI 10.1001/jama.1983.03340170049027
Adopted
individualised, pattern-stratified discussion (CTX-01/CTX-02 at 🟡) — neither reflexive surgery nor reflexive dismissal; the Diehl ORs are issued with their absolute-risk anchor, always together.
BIL-GB-CTX-02 · Very large stone (≥3 cm) and cancer risk
OR 2.4 · ≥3 cm: OR 10.1 · Absolute-risk firewall:
Stone 2.0–2.9 cm: · Stone (Lowenfels 1989: RR 9.2). background cancer risk in untreated stone carriers was estimated at only ~0.2–0.5% over 20 years — the OR multiplies a very small base
Odds of gallbladder cancer by largest stone diameter, vs stones <1 cm
BIL-GB-CTX-02 · Very large stone (≥3 cm) and cancer risk
🟡Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed
Case–control study (81 gallbladder-cancer cases, two control groups, 1976–1980) + interracial corroboration
Variants the registry prints
Arabic short title: الحصوة الكبيرة ≥٣ سم: OR ١٠٫١ لسرطان المرارة (مقابل خطر مطلق صغير); Type: Context — blue
Evidence tier (the registry's wording)
Single classic case–control + corroborating study — both verified via secondary full-text quotation; >40 years old, retained because no newer primary supersedes it and guidelines still reason from it
Dispute — the sources disagree
Traditional teaching · Porcelain GB → operate (cancer risk "up to 25%"); stone >3 cm → operate · All carriers with the finding · Any wall calcification; any large stone · Pre-2000s series · —
EASL CPG 2016 · Porcelain: carcinoma in up to 20% of calcified GBs in X-ray-era series; selective/spotty calcification ~7%, complete homogeneous calcification very low; "may undergo cholecystectomy" — very low quality evidence, weak recommendation; CT confirmation advised. Large stone: case–control ORs (Diehl) against a baseline 20-year cancer risk of ~0.2–0.5% · Same findings, imaging-era stratification · Calcification pattern on CT; stone size bands · 2016 (Diehl 1983) · PMID 27085810 · DOI 10.1001/jama.1983.03340170049027
Adopted
individualised, pattern-stratified discussion (CTX-01/CTX-02 at 🟡) — neither reflexive surgery nor reflexive dismissal; the Diehl ORs are issued with their absolute-risk anchor, always together.
from ~5% in childhood to 40–50% by age 10–50 years · prophylactic cholecystectomy advisable at the time of splenectomy · advised during abdominal surgery for other reasons
HS: gallstone prevalence rises (×4–5 higher with Gilbert syndrome). EASL positions: in HS; in SCD, prophylactic cholecystectomy (to avoid diagnostic confusion with sickle crises) — both very low quality evidence, weak recommendations
Gallstone prevalence and the prophylactic-surgery position in chronic haemolysis
Qualitative — no headline figure issued. · not routinely recommended · heart transplantation · reduce mortality and be cost-effective · Diabetics do NOT need prophylactic cholecystectomy
⚪ EASL: cholecystectomy with asymptomatic stones during abdominal surgery including bariatric surgery, nor in kidney/lung/pancreas transplant settings. Named sub-exception: after , prophylactic cholecystectomy was calculated to in the cited analyses (not cost-effective for kidney/lung). (explicit EASL statement)
Whether asymptomatic stones justify cholecystectomy around transplantation, or in diabetes
BIL-GB-CTX-05 · Persistent abdominal symptoms after cholecystectomy
Symptoms persist in every 3rd to 4th patient
(~25–33%) — EASL's explanation: these symptoms are usually *not* stone-caused (functional dyspepsia, GORD, IBS share the same territory), which is why careful indication-setting precedes surgery
Persistence of pre-operative abdominal symptoms (predominantly non-biliary: dyspepsia, bloating, reflux-type) after cholecystectomy
Gracie & Ransohoff 1982 · 18% cumulative at 15 years (front-loaded) · 123 silent carriers, prospective · Biliary pain or complication, Kaplan–Meier-type cumulative probability · 15 years · 1982 · DOI 10.1056/NEJM198209233071305
Attili (GREPCO) 1995 · 11.9% @2y · 16.5% @4y · 25.8% @10y cumulative colic · 118 asymptomatic carriers · First biliary colic, cumulative incidence · 10 years · 1995 · PMID-verified record (DOI not printed)
Adopted
the EASL + prospective-cohort synthesis — ~1–2% per year in the early years, declining thereafter; cumulative ≈18–26% over 10–15 years; ≈20% at 20 years. Verdict on the 2023 figure: ❌ CORRECTED — "4%/yr" survives only as an early-years ceiling, never as the typical constant rate. Handbook figure = NAT-01 (🔴, dispute shown) + NAT-02 (the sourced 20-year aggregate).
median sick leave 10 days after LC · convalescence ~3 weeks shorter
Majeed RCT (LC vs minilaparotomy): (mean 12.7) vs 14 days (mean 16.0) after mini-laparotomy. EASL (MA of RCTs, LC vs open): hospital stay ~3 days shorter, than open surgery