Gallstones are associated with colonic adenoma: a meta-analysis

The effects of pks+ Escherichia coli and bile acid in colorectal tumorigenesis among people with cholelithiasis or cholecystectomy

BACKGROUND AND AIM

Patients with cholelithiasis (CL) or cholecystectomy (CE) would have more chances of getting colorectal adenoma (CRA) or cancer (CRC). We aimed to figure out the effects of gut microbiota and bile acid on colorectal neoplasm in CL and CE patients.

METHODS

This was a retrospective observational study that recruited 514 volunteers, including 199 people with normal gallbladders (normal), 152 CL, and 163 CE patients. Discovery cohort was established to explore the difference in gut microbiota through 16S rRNA and metagenomics sequencing. Validation cohort aimed to verify the results through quantitative polymerase chain reaction (qPCR).

RESULTS

Significant enrichment of Escherichia coli was found in patients with cholelithiasis or cholecystectomy both in the discovery cohort (16S rRNA sequencing, PNormal-CL = 0.013, PNormal-CE = 0.042; metagenomics sequencing, PNormal-CE = 0.026) and validation cohort (PNormal-CL < 0.0001, PNormal-CE < 0.0001). Pks+ E. coli was found enriched in CL and CE patients through qPCR (in discovery cohort: PNormal-CE = 0.018; in validation cohort: PNormal-CL < 0.0001, PNormal-CE < 0.0001). The differences in bile acid metabolism were found both through Tax4Fun analysis of 16S rRNA sequencing (Ko00120, primary bile acid biosynthesis, PNormal-CE = 0.014; Ko00121, secondary bile acid biosynthesis, PNormal-CE = 0.010) and through metagenomics sequencing (map 00121, PNormal-CE = 0.026). The elevation of serum total bile acid of CE patients was also found in validation cohort (PNormal-CE < 0.0001). The level of serum total bile acid was associated with the relative abundance of pks+ E. coli (r = 0.1895, P = 0.0012).

CONCLUSIONS

E. coli, especially pks+ species, was enriched in CL and CE patients. Pks+ E. coli and bile acid metabolism were found associated with CRA and CRC in people after cholecystectomy.

Postcolonoscopy Colorectal Cancer in a Referral Center for Colorectal Cancer: Prevalence and Risk Factors

Background and Aims

Colonoscopy is effective to detect and remove colorectal lesions. However, after a negative colonoscopy, cancers could be detected during the interval follow-up. This study was designed to identify characteristics and risk factors for postcolonoscopy colorectal cancer - interval type.

Methods

Medical records of individuals who were newly diagnosed with colorectal cancer between January 2018 and December 2019 were reviewed. Clinical, demographic, and endoscopic variables were analyzed. Those with the diagnosis of colorectal cancer between two consecutive colonoscopies performed within the appropriated surveillance range were considered to have postcolonoscopy colorectal cancer - interval type. A comparison between the group of patients with non-postcolonoscopy colorectal cancer - interval type and the group of patients with postcolonoscopy colorectal cancer - interval type was then performed.

Results

During the study period, 491 patients were newly diagnosed with colorectal cancer. Among them, 61 (12.4%) had postcolonoscopy colorectal cancer - interval subtype. Postcolonoscopy colorectal cancer - interval type was three times more prevalent on the proximal colon (p = 0.014) and was associated with the presence of two or more cardiovascular risk factors (aOR = 4.25; p = 0.016), cholecystectomy in the past (aOR = 10.09; p = 0.019), and family history of colorectal cancer on a first-degree relative (aOR = 4.25; p = 0.006). Moreover, isolated cardiovascular risk factors revealed a protective effect for the absence of all cardiovascular risk factors (aOR = 20; p = 0.034). The ROC curve associated with the multivariate model revealed a predictive power of 77.8% (p < 0.001).

Conclusions

Postcolonoscopy colorectal cancer - interval type is more common in the proximal colon and in patients with a family history (first-degree relative) of colorectal cancer, two or more cardiovascular risk factors, and a history of cholecystectomy. All of these are easily detectable in clinical practice and may be of extreme importance in the control of postcolonoscopy colorectal cancer in the near future.

Does postcholecystectomy increase the risk of colorectal cancer?

With the increasing number of cholecystectomy and the high proportion of colorectal cancer in malignant tumors, the question of whether cholecystectomy is a risk factor for colorectal disease has been widely concerned. After reviewing the literature at home and abroad, the authors will summarize the research progress of the correlation between the occurrence of colorectal tumors after cholecystectomy, in order to provide help for the prevention and treatment of colorectal tumors.

Laparoscopic Common Bile Duct Exploration with Gallbladder Preservation: An Innovative Technique for Primary Common Bile Duct Stones

Background: Primary common bile duct (CBD) stones can be treated with laparoscopic CBD exploration (LCBDE), during which cholecystectomy is routinely performed. For patients without gallstones, we have developed a new procedure, LCBDE with gallbladder preservation. The purpose of this study was to evaluate the management of LCBDE with gallbladder preservation at our institution. Methods: Retrospective analysis the clinical data of 105 patients with primary CBD stones. Demographic data, clinical characteristics, preoperative risk factors, and postoperative complications were evaluated. Results: All patients were divided into two groups depending on the presence of gallstones: the primary CBD stone coexistence gallstones group (Group A, n = 15) and the primary CBD stones absence gallstones group (Group B, n = 90). Complete stones clearance was achieved in all patients. There were no significant differences in postoperative complications rates and mortality between the two groups. The mean postoperative hospital stay was 3.2 days for Group A and 4.1 days for Group B (P = .03). Conclusion: This study found that LCBDE with gallbladder preservation can effectively and safely treat primary CBD stones without gallbladder stones.

Gallstone Disease and Risk of Conventional Adenomas and Serrated Polyps: A Prospective Study

BACKGROUND

Gallstone disease has been associated with colorectal cancer and some form of polyps, although the findings are inconclusive. It remains unknown whether gallstone disease influences the initiation of colorectal cancer.

METHODS

We prospectively assessed the association of gallstone disease with risk of colorectal cancer precursors, including conventional adenomas and serrated polyps, in the Nurses' Health Study (1992-2012), the Nurses' Health Study II (1991-2011), and the Health Professionals Follow-up Study (1992-2012). Gallstone diseases were assessed using biennial follow-up questionnaires. Self-reported polyp diagnosis was confirmed by review of medical records. Logistic regression models were used to calculate the ORs with adjustment for smoking and other potential confounders.

RESULTS

Among participants who had undergone a total of 323,832 endoscopies, 16.5% had gallstone disease and 11.3% received cholecystectomy. We documented 1,724, 1,212, and 1,943 cases of conventional adenomas and 1,470, 1,090, and 1,643 serrated polyps in patients with gallstones, cholecystectomy, and either of them, respectively. The OR for adenomas was 1.00 [95% confidence interval (CI): 0.95-1.06] for gallstones, 0.99 (95% CI: 0.93-1.06) for cholecystectomy, and 1.00 (95% CI: 0.95-1.05) for either exposure. The corresponding ORs for serrated polyps were 0.98 (95% CI: 0.92-1.04), 0.99 (95% CI: 0.93-1.06), and 0.97(95% CI: 0.92-1.03), respectively.

CONCLUSIONS

Gallstone disease is not associated with colorectal polyps.

IMPACT

Patients with gallstones appear to have similar risk of colorectal polyps compared with those without and may therefore follow average-risk colorectal cancer screening guidelines.

The Effect of Cholecystectomy on the Risk of Colorectal Cancer in Patients with Gallbladder Stones

To evaluate the risk of colorectal cancer (CRC) after cholecystectomy for gallbladder stones (GBS).

METHODS

This nationwide population-based cohort study analyzed the inpatient data from the Taiwan National Health Insurance Research Database. The study cohort comprised of 83,963 patients aged 20 years undergoing cholecystectomy for GBS between 2000 and 2010. The control cohort comprised the GBS patients without cholecystectomy, who were propensity matched with the study cohort at a 1:1 ratio based on age, sex, comorbidities, and the index date for cholecystectomy.

RESULTS

The cumulative incidence of CRC within 6 months of follow-up was higher in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR (adjusted hazard ratio) = 7.90, 95% confidence interval (CI) = 6.27-9.94; log-rank test, p < 0.001). The cumulative incidence of CRC after 6 months of follow-up was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR = 0.66, 95% CI = 0.60-0.73; log-rank test, p < 0.001), but the reduced risk of CRC for the cholecystectomy cohort was statistically significant only in rectal cancer after separately considering females (aHR = 0.64, 95% CI = 0.46-0.88) and males (aHR = 0.59, 95% CI = 0.44-0.79).

CONCLUSIONS

The positive association between cholecystectomy and the CRC risk within the first 6 months after cholecystectomy might be due to a detection bias or pre-existing CRC. However, cholecystectomy is associated with a decreased risk of rectal cancer, rather than proximal or distal colon cancer, after more than 6 months of follow-up.

[Diseases of biliary tract in the context of association with oncological diseases of the digestive system]

Cancers of the gastrointestinal tract are widespread among the population and cause significant damage to the health care system. In order to improve the strategy of preventive measures and the detection of oncological diseases at the early stages, it is necessary to provide timely impact on possible risk factors contributing to the onset and progression of malignant neoplasms. This review demonstrates the association between the pathology of the biliary tract and oncological diseases of the digestive system, discusses the possible mechanisms of the influence of cholelithiasis and cholecystectomy on the development of malignant neoplasms of various parts of the gastrointestinal tract.

Role of gallbladder-preserving surgery in the treatment of gallstone diseases in young and middle-aged patients in China: results of a 10-year prospective study

BACKGROUND

The aim of the study was to prospectively investigate the long-term effects of gallbladder-preserving cholecystolithotomy in a selected population of Chinese patients.

METHODS

Between January 2007 and December 2016, all gallstone patients who met the criteria for gallbladder-preserving cholecystolithotomy in our hospital were included in the study and followed prospectively. The primary endpoint was the time of recurrence of cholecystolithiasis, and the secondary endpoint was the end of the study. The data were collected in half-year intervals.

RESULTS

We surveyed 81 male patients and 135 female patients. Most patients (176/216) had only 1 gallstone in the gallbladder. All patients underwent gallbladder-preserving cholecystolithotomy successfully. After the operation, 200 of the 216 patients were symptom free. There was no difference in the percentage of gallbladder emptying (the gallbladder emptying index) between the time prior to the operation and 6 months after gallbladder-preserving cholecystolithotomy (0.47 ± 0.18 vs 0.49 ± 0.18, P = .837). Twenty patients (9.3%) developed recurrent gallstones during the follow-up period. There was no difference in stone recurrence between patients who were treated with ursodeoxycholic acid for 6 months postoperatively and those treated with ursodeoxycholic acid for 12 months (P = .589). Most instances of recurrence occurred within 2 years of gallbladder-preserving cholecystolithotomy. Overall, the recurrence rates at 6, 12, and 24 months were 2.3%, 3.7%, and 7.6%, respectively.

CONCLUSION

Gallbladder-preserving cholecystolithotomy is a safe and effective operative procedure for selected Chinese patients. The function of the gallbladder can be maintained after gallbladder-preserving cholecystolithotomy. The recurrence of cholelithiasis is infrequent in this Chinese population with a mean follow-up of 59 (range 8 to 120) months, and most patients with recurrent gallbladder stones experience no symptoms or only minor symptoms.

Gallbladder stones and gallbladder polyps associated with increased risk of colorectal adenoma in men

BACKGROUND AND AIMS

Most cases of colorectal cancer develop via an adenoma to carcinoma sequence. Gallbladder polyps share some risk factors with colorectal polyps. Little is known about the relationship between gallbladder diseases and different status of colorectal polyps by gender. This study was to investigate the association of gallbladder stones and polyps with colorectal adenomas by gender in a Taiwanese population.

METHODS

A total of 7066 eligible subjects who underwent a total colonoscopy as a part of health check-up between January 2001 and August 2009 were recruited. Colonoscopic findings were classified into polyp-free, non-neoplastic polyps and colorectal adenomas. Gallbladder stones and gallbladder polyps were diagnosed based on ultrasonographic findings.

RESULTS

There was a significant difference in the status of colon polyps between subjects with and without gallbladder polyps. However, the status of colon polyps was not significantly different between subjects with or without gallbladder stones. After adjusting obesity, fasting plasma glucose, and other variables, there was a positive relationship between gallbladder polyps and colorectal adenomas (odds ratio [OR]: 1.396, 95% confidence interval [CI]: 1.115-1.747) but not non-neoplastic polyps in all subjects. In men, gallbladder polyps (OR: 1.560, 95% CI: 1.204-2.019) and gallbladder stones (OR: 1.465, 95% CI 1.081-1.984) were positively associated with colorectal adenomas. In women, neither gallbladder polyps nor gallbladder stones were significantly related to colon polyps.

CONCLUSIONS

Both gallbladder polyps and gallbladder stones were associated with an increased risk of colorectal adenomas in men but not in women. Gender difference was significant for the association between gallbladder lesions and colorectal polyps.

Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies

OBJECTIVE

This study aimed to elucidate the effects of cholecystectomy on the risk of colorectal cancer (CRC) by conducting a meta-analysis of 10 cohort studies.

METHODS

The eligible cohort studies were selected by searching the PubMed and EMBASE databases from their origination to June 30, 2016, as well as by consulting the reference lists of the selected articles. Two authors individually collected the data from the 10 papers. When the data showed marked heterogeneity, we used a random-effects model to estimate the overall pooled risk; otherwise, a fixed effects model was employed.

RESULTS

The final analysis included ten cohort studies. According to the Newcastle-Ottawa Scale (NOS), nine papers were considered high quality. After the data of these 9 studies were combined, an increased risk of CRC was found among the individuals who had undergone cholecystectomy (risk ratio (RR) 1.22; 95% confidence interval (CI) 1.08-1.38). In addition, we also found a promising increased risk for colon cancer (CC) (RR 1.30, 95% CI 1.07-1.58), but no relationship between cholecystectomy and rectum cancer (RC) (RR 1.09; 95% CI 0.89-1.34) was observed. Additionally, in the sub-group analysis of the tumor location in the colon, a positive risk for ascending colon cancer (ACC) was found (RR 1.18, 95% CI 1.11-1.26). After combining the ACC, transverse colon cancer (TCC), sigmoid colon cancer (SCC) and descending colon cancer (DCC) patients, we found a positive relationship with cholecystectomy (RR 1.18, 95% CI 1.11-1.26). Furthermore, after combining the ACC and DCC patients, we also found a positive relationship with cholecystectomy (RR 1.28; 95% CI 1.11-1.26) in the sub-group analysis. In an additional sub-group analysis of patients from Western countries, there was a positive relationship between cholecystectomy and the risk of CRC (RR 1.20; 95% CI 1.05-1.36). Furthermore, a positive relationship between female gender and CRC was also found (RR 1.17; 95% CI 1.03-1.34). However, there was no relationship between gender and CC or RC. Furthermore, no publication bias was observed, and the sensitivity analysis indicated stable results.

CONCLUSIONS

This meta-analysis of 10 cohort studies revealed that cholecystectomy is associated with an increased risk for CRC, CC and ACC, particularly in Western countries. No relationship between cholecystectomy and RC was observed. There was no relationship between gender and either CC or RC, but a positive relationship between female gender and CRC was observed.

Alcohol consumption and risk of gallstone disease: a meta-analysis

Epidemiology studies have been carried out to investigate the association between alcohol consumption and the risk of gallstone disease, but the results remain controversial. We carried out a meta-analysis to quantitatively summarize the evidences from observational studies on alcohol consumption and the risk of gallstone disease. Eligible studies published in English were identified by searching PubMed, Web of Science, and Embase databases. The random-effect model was used to calculate the pooled relative risks (RRs) with 95% confidence intervals (CIs). Restricted cubic splines were used to assess the dose-response relationship. Eight cohort studies and 10 case-control studies were included in our meta-analysis. The pooled RR of gallstone disease for the highest versus the lowest alcohol consumption was 0.62 (95% CI: 0.49-0.78). Statistically significant associations were also found in stratified analysis by study design (cohort studies: RR=0.66, 95% CI: 0.48-0.91 and case-control studies: RR=0.58, 95% CI: 0.45-0.73). With respect to sex, both men (RR=0.57, 95% CI: 0.4-0.8) and women (RR=0.64, 95% CI: 0.53-0.77) showed statistically significant associations between alcohol consumption and the risk of gallstone disease. A linear dose-response relationship was found between alcohol consumption and gallstone disease risk and the risk of gallstone disease decreased by 12% (RR=0.88, 95% CI: 0.84-0.92; Pnonlinearity=0.079) for each 10 g/day increment in alcohol consumption. This meta-analysis suggests that alcohol consumption is associated with significantly decreased risk of gallstone disease.

High risk factors for recurrence after resection of colorectal polyps

AIM: To investigate the high risk factors for recurrence after resection of colorectal polyps.

METHODS: A retrospective analysis was performed of patients who underwent endoscopic resection of colorectal polyps more than twice from January 2012 to December 2015 at Shanghai Putuo District Central Hospital to identify the high risk factors for recurrence.

RESULTS: A total of 54 patients was included. Univariate analysis showed that male gender, old age, low intestinal cleaning degree, adenomatous polyps, polyps < 1 cm, APC electric cauterization combined with high frequency electrocoagulation, and multiple polyps were risk factors for postoperative recurrence of colorectal polyps. Multivariate analysis showed that only age was an independent risk factor for postoperative recurrence of colorectal polyps.

CONCLUSION: Age, gender, polyp number, polyp pathology, and intestinal cleanliness are risk factors for postoperative recurrence of colorectal polyps. Insufficient bowel preparation and smaller polyps will increase the rate of missed diagnosis and increase the risk of postoperative recurrence.

Diagnosis and treatment of cholelithiasis: A review based on meta-analyses

Cholelithiasis is common disease whose diagnosis and treatment are important for doctors. Nowadays, main diagnostic methods include X-ray, ultrasonography, CT and MRI. Major treatments are surgical and endoscopic approaches. With evidence based medicine developing, more and more meta-analyses, which provide much best evidence, are reported. By means of summarizing these meta-analyses, we provide the best evidence for clinicians to update their knowledge on the diagnosis and treatment of cholelithiasis.

The Risk of Colorectal Neoplasia in Patients with Gallbladder Diseases

Cholecystectomy is associated with an increased risk of colorectal cancer, but little is known about the relationship between gallbladder disease and colorectal adenoma. Gallbladder polyps and colorectal neoplasia (CRN) share several risk factors such as obesity, diabetes and metabolic syndrome, which might account for their association. In this study, we investigated whether asymptomatic patients with gallbladder disease are at increased risk of CRN and identified the factors to their association. The study population consisted of 4,626 consecutive, asymptomatic individuals drawn from a prospective health check-up cohort who underwent both ultrasonography and colonoscopy screening. The prevalence of CRNs in patients with gallbladder polyps or gallstones was significantly higher than that in the control group (32.1% vs. 26.8%; P = 0.032, 35.8% vs. 26.9%; P = 0.020). A multivariate regression analysis showed that gallbladder polyps were an independent risk factor for CRN [adjusted odds ratio (OR): 1.29; 95% confidence interval (CI); 1.03-1.62] whereas gallstones were not (adjusted OR: 1.14; 95% CI: 0.79-1.63). The adjusted OR for the risk of CRN was 1.12 for gallbladder polyps < 5 mm (95% CI, 0.85-1.46) and 1.79 for gallbladder polyps ≥ 5 mm (95% CI, 1.15-2.77). The prevalence of CRN increased with increasing polyp size (P trend = 0.022). Our results suggest that colorectal neoplasia is significantly related to gallbladder polyps, especially those ≥ 5 mm.

Risk of primary liver cancer associated with gallstones and cholecystectomy: a meta-analysis

Background

Recent epidemiological evidence points to an association between gallstones or cholecystectomy and the incidence risk of liver cancer, but the results are inconsistent. We present a meta-analysis of observational studies to explore this association.

Methods

We identified studies by a literature search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant conference proceedings up to March 2014. A random-effects model was used to generate pooled multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Between-study heterogeneity was assessed using Cochran’s Q statistic and the I².

Results

Fifteen studies (five case-control and 10 cohort studies) were included in this analysis. There were 4,487,662 subjects in total, 17,945 diagnoses of liver cancer, 328,420 exposed to gallstones, and 884,507 exposed to cholecystectomy. Pooled results indicated a significant increased risk of liver cancer in patients with a history of gallstones (OR = 2.54; 95% CI, 1.71–3.79; n = 11 studies), as well as cholecystectomy (OR = 1.62; 95% CI, 1.29–2.02; n = 12 studies), but there was considerable heterogeneity among these studies. The effects estimates did not vary markedly when stratified by gender, study design, study region, and study quality. The multivariate meta-regression analysis suggested that study region and study quality appeared to explain the heterogeneity observed in the cholecystectomy analysis.

Conclusions

Our results suggest that individuals with a history of gallstones and cholecystectomy may have an increased risk of liver cancer.

A new strategy of minimally invasive surgery for cholecystolithiasis: calculi removal and gallbladder preservation

BACKGROUND

Cholecystolithiasis is a common disease. Cholecystectomy is the main treatment method but is associated with various complications in some patients. This study explores a novel, minimally invasive surgery for the removal of calculi and the preservation of the gallbladder using a laparoscope combined with the soft choledochoscope.

METHOD

A retrospective analysis was conducted between January 2010 and December 2012 in 65 patients with cholecystolithiasis who underwent the minimally invasive surgery for calculi removal and gallbladder preservation.

RESULTS

In 61 cases of gallstone removal, the gallbladder was preserved perfectly with no complications. The other 4 cases were switched to laparoscopic cholecystectomy because of tiny stones blocking the cystic duct or submucosal stones. The success rate was 93.8%. Follow-up included both clinical assessment and ultrasound examination every 6 months after the operation. The patients with preoperative symptoms were symptom-free, and gallbladder function was well preserved. The overall stone recurrence rate was 4.92% at a mean follow-up of 26 months (range 6-40).

CONCLUSIONS

Using the laparoscope combined with the soft choledochoscope for gallbladder-preserving cholecystolithotomy can remove stones, preserve gallbladder function, and effectively avoid the various complications of cholecystectomy. In our follow-up, gallbladder function was not affected and the stone recurrence rate was quite low.

New understandings about gallbladder function

The function of the gallbladder is to store and concentrate bile. Due to the high incidence of diseases such as gallstones, cholecystectomy has become one of the most common surgical procedures. Although cholecystectomy is a successful treatment for most patients, the loss of gallbladder function may contribute to chronic diarrhea and increase the incidence of proximal colon cancer, pancreatic cancer, hepatocellular carcinoma and esophageal adenocarcinoma. With the development of endoscopic technology and introduction of drugs that may prevent recurrence of gallstones, cholecystolithotomy with gall bladder preservation has become another choice for symptomatic gallstones, and it preserves the function of the gallbladder after the removal of gallstones. This may avoid the complications associated with the loss of gallbladder function.