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Comment & Response
April 28, 2021

Nonoperative Management for Pregnant Individuals With Gallstone Disease in the Third Trimester

Author Affiliations
  • 1Department of Surgery, Massachusetts General Hospital, Boston
  • 2Department of Surgery, Washington University in St Louis, St Louis, Missouri
JAMA Surg. 2021;156(8):795-796. doi:10.1001/jamasurg.2021.0637

To the Editor We read with interest the recent JAMA Network Insight by Schwulst and Son on the management of gallstone disease during pregnancy advocating cholecystectomy in all trimesters.1 While the authors emphasized the importance of trimester in the setting of gallbladder disease, their recommendations are based on small case series, as are the SAGES (Society of American Gastrointestinal Endoscopic Surgeons) guidelines. These reports are too small to distinguish the effect of timing of treatment in pregnancy on outcome. Conversely, we recently published a large series of pregnant women with gallstone disease treated in the outpatient, emergency department, and inpatient settings and express concern that recommendations with regard to the third trimester are inappropriate.2

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