1
|
Tehrani AN, Saadati S, Yari Z, Salehpour A, Sadeghi A, Daftari G, Ghorbani M, Hekmatdoost A. Dietary fiber intake and risk of gallstone: a case-control study. BMC Gastroenterol 2023; 23:119. [PMID: 37041462 PMCID: PMC10091554 DOI: 10.1186/s12876-023-02752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Gallstone disease (GSD) and its complications are major public health issues globally. Although many community-based studies had addressed the risk factors for GSD, little is known about the associations between dietary factors and risk of disease. The present study aimed to investigate the potential associations between dietary fibers with the risk of gallstone disease. METHODS In this case-control study, 189 GSD patients with less than one month of diagnosis and 342 age‑matched controls were enrolled. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models. RESULTS Comparing the highest versus the lowest tertile, significant reverse associations were observed between odds of GSD and each category of dietary fiber intake including total (OR T3 vs. T1 = 0.44, 95% CI: 0.37-0.7, P for trend = 0.015), soluble (OR T3 vs. T1 = 0.51, 95% CI: 0.3-0.8, P for trend = 0.048) and insoluble (OR T3 vs. T1 = 0.56, 95% CI: 0.3-0.9, P for trend < 0.001). The relationship between dietary fiber intake and the risk of gallstones was more prominent in overweight and obese subjects than in subjects with a normal body mass index. CONCLUSION Comprehensive assessment of the associations of dietary fiber intake with GSD showed that higher intakes of dietary fiber were significantly associated with reduced GSD risk.
Collapse
Affiliation(s)
- Asal Neshatbini Tehrani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeede Saadati
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Zahra Yari
- Department of Nutrition Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, West Arghavan St. Farahzadi Blvd., Sharake Qods, Tehran, Iran.
| | - Amin Salehpour
- School of Public Health, Occupational Health Research Center, Iran Universityof Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Research Institute for Gastroenterology and Liver Diseases of Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Daftari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Ghorbani
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azita Hekmatdoost
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| |
Collapse
|
2
|
Kwon MJ, Lee JW, Kang HS, Lim H, Kim ES, Kim NY, Choi HG, Kim MJ. Association between Gallstone Disease and Statin Use: A Nested Case-Control Study in Korea. Pharmaceuticals (Basel) 2023; 16:ph16040536. [PMID: 37111293 PMCID: PMC10143191 DOI: 10.3390/ph16040536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
The correlation between statin use and the development of gallstone disease remains controversial. Existing data, primarily based on Caucasian populations, are biased, thus necessitating validation studies involving Asian cohorts. We conducted a nested case-control study using data from the Korean National Health Insurance Service Health Screening Cohort (2002-2019) to determine the likelihood of gallstone disease according to periods of previous statin use and type of statin. Among the 514,866 participants, 22,636 diagnosed with gallstones at ≥2 clinic visits (using the International Classification of Diseases, 10th revision, code K80) were matched 1:4 to 90,544 controls for age, sex, income, and residential area, and their statin prescription history for 2 years prior to the index date was examined. Propensity-score-weighted odds ratios (ORs) for gallstone disease were calculated using conditional logistic regression. Long-term use (>545 days) of any statin or lipophilic statins was associated with lower odds of incident gallstones (OR = 0.91, 95% confidence interval [CI] = 0.86-0.96, p < 0.001 and OR = 0.88, 95% CI = 0.83-0.93, p < 0.001, respectively) after adjusting for confounders. Short-term use (180-545 days) of any statin or hydrophilic statins was not statistically related to incident gallstones. In summary, prior statin medication, particularly long-term lipophilic statin use, may confer a preventive advantage against gallstone disease.
Collapse
Affiliation(s)
- Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Jung Woo Lee
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea
| | - Hyo Geun Choi
- Suseo Seoul ENT Clinic and MD Analytics, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| |
Collapse
|
3
|
Nugent JP, Li J, Pang E, Harris A. What's new in the hot gallbladder: the evolving radiologic diagnosis and management of acute cholecystitis. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:31-46. [PMID: 35230497 DOI: 10.1007/s00261-022-03451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
Abstract
Acute cholecystitis (AC) is a common condition and its incidence is rising. New technologies have advanced the imaging diagnosis of AC, providing more structural and functional information as well as allowing the radiologist to distinguish AC from mimics and identify complications from both the disease and its management. Dual energy CT aids in detecting gallstones and gallbladder wall enhancement, which helps to diagnose AC and identify its complications. Similarly, contrast-enhanced and non-contrast perfusion ultrasound techniques improve detection of abnormal gallbladder wall enhancement. Advances in MR imaging including hepatobiliary contrast agents aid in characterizing post-cholecystectomy complications such as bile leaks. Newer interventional techniques have also expanded the suite of options for minimally invasive management. Lumen apposing metal stents provide more options for conservative treatment in non-surgical candidates and are compared to a standard percutaneous cholecystostomy. Radiologists should be familiar with these advanced imaging methods and intervention techniques and the value they can bring to the diagnosis and management of AC.
Collapse
Affiliation(s)
- James P Nugent
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada.
| | - Jessica Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Emily Pang
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Alison Harris
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| |
Collapse
|
4
|
Cholecystectomy reduces the risk of myocardial and cerebral infarction in patients with gallstone-related infection. Sci Rep 2022; 12:16749. [PMID: 36202881 PMCID: PMC9537563 DOI: 10.1038/s41598-022-20700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
We compared the risk of myocardial infarction (MI) or cerebral infarction (CI) in patients with or without-gallstone-related infection (GSI) and change in the risk following cholecystectomy. GSI (n = 84,467) and non-GSI (n = 406,800) patients with age- and sex-matched controls (n = 4,912,670) were identified from Korean population based data. The adjusted hazard ratios (aHRs) of MI or CI were analyzed in both groups treated with or without cholecystectomy. Subgroup analysis was performed for both sexes and different ages. The risk of MI or CI was higher in the GSI group than in the non-GSI group (aHR for MI; 1.32 vs. 1.07, aHR for CI; 1.24 vs. 1.06, respectively). The risk reduction rate of MI following cholecystectomy was 11.4% in the GSI group, whereas it was 0% in the non-GSI group. The risk of CI after cholecystectomy was more reduced in the GSI group than in the non-GSI group (16.1% and 4.7%, respectively). The original risk of MI or CI in patients with gallstones and risk reduction rates following cholecystectomy were higher in females and younger patients than in males and older patients. Increased risk of MI or CI and greater risk reduction following cholecystectomy were seen in patients with GSI.
Collapse
|
5
|
Ahn HS, Kim HJ, Kang TU, Park SM. Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinoma. J Gastroenterol Hepatol 2022; 37:669-677. [PMID: 34907591 DOI: 10.1111/jgh.15759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/08/2021] [Accepted: 12/05/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Gallstones have been reported to be positively associated with hepatobiliary cancers. However, risks of these cancers by cholecystectomy or in patients with complicated gallstones are controversial. We studied the effect of cholecystectomy on the risk of cholangiocarcinoma (CCA) or hepatocellular carcinoma (HCC) in patients with gallstones and subgroup of complicated gallstones. METHODS Patients with gallstone disease (n = 958 677) and age-matched and sex-matched controls (n = 9 586 770) were identified using the Korean National Health Insurance database. Complicated gallstones were defined as gallstones associated with acute cholecystitis or acute cholangitis. Adjusted hazard ratios (adjusted hazard ratios, 95% confidence interval) of CCA and HCC incidences were evaluated in patients with gallstones who received cholecystectomy compared to the controls. We also analyzed these effects in patients with complicated gallstones. RESULTS Patients with gallstones showed increased risks of CCA (1.80, 1.67-1.93) and HCC (1.03, 1.00-1.07) compared with controls. Cholecystectomy had minimal effects on the risks of CCA (1.94, 1.76-2.14) and HCC (0.93, 0.87-0.99) compared with those without cholecystectomy. However, patients with complicated gallstones showed highly increased CCA risk (5.62, 4.89-6.46) and a 30% risk reduction after cholecystectomy (3.91, 3.43-4.46). Risk reduction by cholecystectomy was greater for extrahepatic CCA than for intrahepatic CCA or ampulla of Vater cancer. However, the risk of HCC was not different in patients with complicated gallstones and those who underwent cholecystectomy compared to controls. CONCLUSION The risk of CCA was markedly increased in patients with complicated gallstones and was partially reduced by cholecystectomy. The risk change of HCC was minimal with gallstones or cholecystectomy.
Collapse
Affiliation(s)
- Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Tae Uk Kang
- Health and Wellness College, Sungshin Women's University, Seoul, South Korea
| | - Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| |
Collapse
|
6
|
Abstract
IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year. OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of maternal-fetal complications (1.6% for early vs 18.4% for delayed) and is recommended during all trimesters. In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up (15.2%) compared with nonoperative management (29.3%). A percutaneous cholecystostomy tube, in which a drainage catheter is placed in the gallbladder lumen under image guidance, is an effective therapy for patients with an exceptionally high perioperative risk. However, percutaneous cholecystostomy tube placement in a randomized trial was associated with higher rates of postprocedural complications (65%) compared with laparoscopic cholecystectomy (12%). For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy. CONCLUSIONS AND RELEVANCE Acute cholecystitis, typically due to gallstone obstruction of the cystic duct, affects approximately 200 000 people in the US annually. In most patient populations, laparoscopic cholecystectomy, performed within 3 days of diagnosis, is the first-line therapy for acute cholecystitis.
Collapse
Affiliation(s)
- Jared R Gallaher
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| | - Anthony Charles
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| |
Collapse
|
7
|
Yang Y, Liu MH, Li Y. Association Between Cholecystectomy and Gastric Cancer Risk: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:667736. [PMID: 35174075 PMCID: PMC8841561 DOI: 10.3389/fonc.2022.667736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 01/05/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives Although several epidemiological studies have attempted to evaluate the relationship between cholecystectomy and gastric cancer risk, the findings have been controversial. This study aimed to carry out a systematic review and meta-analysis following the reporting guidelines to comprehensively analyze and quantify the evidence of the aforementioned association. Methods Studies were identified by searching the Medline (PubMed), Embase, and Web of Science from inception to November 30, 2020, with only studies published in English being considered. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random-effects models. Results Eight studies (five cohort studies and three case–control studies) with a total of 26,063 gastric cancer patients and 848,081 participants were included. The summarized RR of the relationship between cholecystectomy and gastric cancer risk was 1.11 (95%CI: 1.03–1.20), with low heterogeneity (P = 0.117, I2 = 37.8%). These positive findings were consistent in most subgroup analyses like region in Asia, number of cases ≥200, cohort study design, sex in male, low risk of bias, exposure collection by database, and adjustments made for age, gender, calendar year. Of note, we also observed positive association between cholecystectomy and non-cardia of gastric cancer risk (RR = 1.17, 95%CI: 1.04–1.33). No publication bias was present. Conclusions The aforementioned evidence suggested that a history of cholecystectomy was associated with a slightly elevated risk of gastric cancer. Results of most subgroup analyses also supported the main findings. More prospective studies are warranted to further validate these findings.
Collapse
|
8
|
Liang KW, Huang HH, Wang L, Lu WY, Chou YH, Tantoh DM, Nfor ON, Chiu NY, Tyan YS, Liaw YP. Risk of gallstones based on ABCG8 rs11887534 single nucleotide polymorphism among Taiwanese men and women. BMC Gastroenterol 2021; 21:468. [PMID: 34906072 PMCID: PMC8672562 DOI: 10.1186/s12876-021-02060-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gallstones are abnormal masses caused by impaired metabolism of cholesterol, bilirubin, or bile salts in the gallbladder or biliary tract. ATP-binding cassette subfamily G member 8 (ABCG8) is a protein that regulates cholesterol efflux from the liver. Genome-wide association studies (GWAS) and meta-analyses of GWAS revealed the ABCG8 rs11887534 variant as the most common genetic determinant of gallstones in humans. These findings have not been extensively replicated in Taiwanese. Therefore, we appraised the relationship between gallstones and rs11887534 in a relatively large Taiwanese sample. METHODS We retrieved data collected through questionnaires, physical and biochemical tests from the Taiwan Biobank Bank (TWB). The study participants comprised 7388 men and 13,880 women who voluntarily enrolled in the Taiwan Biobank project between 2008 and 2019. Gallstones were self-reported. RESULTS The overall sample size was 21,268 comprising 938 gallstone patients and 20,330 non-gallstone individuals. Among the participants, 20,640 had the GG and 628 had the GC + CC genotype. At p-value < 0.05, the baseline genotypes and gallstone status between men and women were not significantly different. The risk of gallstones was higher in participants having the GC + CC compared to the GG genotype: odds ratio (OR); 95% confidence interval (CI) = 1.698; 1.240-2.325), but was lower in men compared to women (OR = 0.763; 95% CI = 0.638-0.913). Compared to men with the rs11887534 GG genotype, women with the GG and GC + CC genotypes had a higher risk of gallstone (OR; 95% CI = 1.304; 1.087-1.565 for GG and 2.291; 1.514-3.467 for GC + CC). The positive association between GC + CC and gallstones was retained after we restricted the analysis to the female participants (OR; 95% CI = 1.789 = 1.208-2.648). Hormone use was associated with an elevated risk of gallstones (OR; 95% CI = 1.359; 1.107-1.668). Relative to GG and no hormone use, we found a significantly high risk among hormone users with the GC + CC genotype (OR; 95% CI = 3.596; 1.495-8.650). CONCLUSIONS The rs11887534 GC + CC genotype was independently associated with a higher risk of gallstones. This risk was much higher among women, especially those who used hormones for various gynecological purposes.
Collapse
Grants
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- CSH-2021-C-032 Chung Shan Medical University Hospital
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
- MOST 109-2121-M-040-002; MOST 110-2121-M-040-002; MOST 109-2811-M-040-500; MOST 110-2811-M-040-001 Ministry of Science and Technology, Taiwan
Collapse
Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Lee Wang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Wen-Yu Lu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Radiation Oncology, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Disline Manli Tantoh
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan.
| | - Neng-Yu Chiu
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Yeu-Sheng Tyan
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, 40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan
| | - Yung-Po Liaw
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan.
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan.
| |
Collapse
|
9
|
Chiang HY, Lin KTR, Hsiao YL, Huang HC, Chang SN, Hung CH, Chang Y, Wang YC, Kuo CC. Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy. Diabetes Care 2021; 44:107-115. [PMID: 33177174 PMCID: PMC7783940 DOI: 10.2337/dc19-0963] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR] 1.19; 95% CI 1.06-1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR 1.17; 95% CI 1.07-1.29) than did those with POBG levels of <102 mg/dL. A positive dose-response curve between POBG and an adjusted risk of a LOS of >3 days was observed, although the curve starts to flatten at a POBG level of ∼130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy or laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.
Collapse
Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Ting Robin Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ya-Luan Hsiao
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,PhD Program for Cancer Biology and Drug Discovery, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Hung
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan
| | - Ying Chang
- Department of Nursing, China Medical University Hospital and College of Nursing, Taichung, Taiwan
| | - Yu-Chun Wang
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan .,Department of Acute Care Surgery, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan .,College of Medicine, China Medical University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
10
|
Wei CY, Chuang SH, Lin CL, Kung WM, Tai HC, Tsai KWK, Kao CH, Chen CH, Yeh YH, Hsu CY. Reduced risk of stroke following cholecystectomy: A nationwide population-based study. J Gastroenterol Hepatol 2019; 34:1992-1998. [PMID: 31165511 DOI: 10.1111/jgh.14678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Gallstones and stroke are common diseases worldwide. The relationship between gallstones and stroke has been documented in the literature. In this work, to characterize the risk of stroke among gallstone patients with and without cholecystectomy, we investigated the effects of cholecystectomy in a nationwide population-based retrospective cohort study. METHODS Data were obtained from Taiwan's National Health Insurance Research Database. The study comprised 155 356 gallstone patients divided into two groups: those with and without cholecystectomy. RESULTS During the study period (2000-2012), 19 096 (17.8/1000 person-years) gallstone patients without cholecystectomy and 11 913 (10.6/1000 person-years) gallstone patients with cholecystectomy had a stroke. Following gallstone removal, the patients exhibited a significant decrease in the risk of overall stroke (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.59-0.61), ischemic stroke (HR = 0.59, 95% CI = 0.58-0.61), and hemorrhagic stroke (HR = 0.56, 95% CI = 0.53-0.59). Asymptomatic and symptomatic gallstone patients had lower overall stroke risk after cholecystectomy (HR = 0.64, 95% CI = 0.62-0.67 and HR = 0.57, 95% CI = 0.56-0.59) than did asymptomatic gallstone patients without cholecystectomy. CONCLUSIONS This population-based cohort study demonstrated that cholecystectomy is related to reduce the risk of overall stroke, ischemic stroke, and hemorrhagic stroke. Preventive measures for stroke may be considered for gallstone patients, particularly those presenting risk factor(s) for stroke.
Collapse
Affiliation(s)
- Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Shu-Hung Chuang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Hsu Chih Tai
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Kevin Wen-Kai Tsai
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chien-Hua Chen
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yung-Hsiang Yeh
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| |
Collapse
|
11
|
Kim SY, Bang WJ, Lim H, Lim MS, Kim M, Choi HG. Increased risk of gallstones after gastrectomy: A longitudinal follow-up study using a national sample cohort in korea. Medicine (Baltimore) 2019; 98:e15932. [PMID: 31145363 PMCID: PMC6709130 DOI: 10.1097/md.0000000000015932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study sought to evaluate the association between gastrectomy and the occurrence of gallstones using a national sample cohort from Korea.Data from 2002 to 2013 were collected for individuals ≥20 years of age in the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). We extracted data for patients who had undergone gastrectomy (n = 1998) and a 1:4 matched control group (n = 7992) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Gastrectomies were identified using operation codes (Q2533-Q2537, Q2594-Q2596, and Q2598). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using Cox proportional hazard models, and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed based on age and sex.The adjusted HR for gallstones was 1.77 (95% CI = 1.34-2.35, P < .001) in the gastrectomy group compared to control. Consistent HRs were found in the analyses of all of the subgroups determined using age and sex.The occurrence of gallstones was increased in the patients who had undergone gastrectomy compared to their matched control group.
Collapse
Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Woo Jin Bang
- Department of Internal Medicine, Hallym University College of Medicine, Anyang
| | - Hyun Lim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang
| | - Man Sup Lim
- Department of General Surgery, Hallym University College of Medicine, Chuncheon
| | | | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
12
|
Yoo MC, Yoo SD, Chon J, Han YR, Lee SA. Acute cholecystitis as a rare and overlooked complication in stroke patients: A retrospective monocentric study. Medicine (Baltimore) 2019; 98:e14492. [PMID: 30817566 PMCID: PMC6831438 DOI: 10.1097/md.0000000000014492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/16/2018] [Accepted: 01/18/2019] [Indexed: 11/27/2022] Open
Abstract
Acute cholecystitis (AC) is a rare but possible medical complication found in stroke patients. As many stroke patients present with neurologic symptoms, such as altered mental status, motor weakness, global aphasia, or dysarthria, clinical symptoms and signs of AC are often unexpressed or overlooked. As a result, the diagnosis of AC is often delayed with subsequent secondary complications in these stroke patients. This study aims to evaluate the clinical incidence, manifestations, and predictive factors of AC in stroke patients.A retrospective cohort study was conducted between January 2013 and December of 2017 of all stroke patients (n = 2699) who have been admitted to our stroke center of the university hospital. We evaluated patient demographics, presenting symptoms, vital signs, laboratory results, mean initial consecutive fasting time, mean total fasting time, modified Rankin Scale (mRS), as well as radiological findings of abdominal computed tomography (CT) or ultrasonography.AC was diagnosed in 28 of the 2699 patients (1.04%). Of these patients with AC, gallbladder stones (calculous cholecystitis) were found in 4 patients (14.3%), and 24 patients (85.7%) were diagnosed with a calculous cholecystitis. Subgroup analysis revealed that of the 28 stroke patients with AC, those who underwent neurosurgical intervention (n = 15) had increased incidence of AC compared with those who did not (2.3% vs 0.6%, respectively, P < .001). Furthermore, the initial consecutive fasting time, total fasting time, and mRS were all predictive factors (P < .05) for developing AC in stroke patients.The incidence of AC was higher in acute stroke patients who required neurosurgical intervention, with longer initial consecutive fasting time, total fasting time, and higher mRS. We recommend early enteral nutrition and to maintain a high degree of clinical suspicion to make an early diagnosis of AC in stroke patients for improved outcome.
Collapse
Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University Hospital at Gangdong
| | - Seung Don Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine
| | - Jinmann Chon
- Department of Physical Medicine & Rehabilitation, College of Medicine
| | - Young Rok Han
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University Hospital at Gangdong
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Ah Lee
- Department of Physical Medicine & Rehabilitation, College of Medicine
| |
Collapse
|
13
|
Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography. Sci Rep 2019; 9:2168. [PMID: 30778100 PMCID: PMC6379409 DOI: 10.1038/s41598-018-38428-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
There are no clinical guidelines for the timing of cholecystectomy (CCY) after performing therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. We tried to analyze the clinical practice patterns, medical expenses, and subsequent outcomes between the early CCY, delayed CCY, and no CCY groups of patients. 1827 choledocholithiasis patients who underwent therapeutic ERCP were selected from the nationwide population databases of two million random samples. These patients were further divided into early CCY, delayed CCY, and no CCY performed. In our analysis, 1440 (78.8%) of the 1827 patients did not undergo CCY within 60 days of therapeutic ERCP, and only 239 (13.1%) patients underwent CCY during their index admission. The proportion of laparoscopic CCY increased from 37.2% to 73.6% in the delayed CCY group. There were no significant differences (p = 0.934) between recurrent biliary event (RBE) rates with or without early CCY within 60 days of ERCP. RBE event-free survival rates were significantly different in the early CCY (85.04%), delayed CCY (89.54%), and no CCY (64.45%) groups within 360 days of ERCP. The method of delayed CCY can reduce subsequent RBEs and increase the proportion of laparoscopic CCY with similar medical expenses to early CCY in Taiwan’s general practice environment.
Collapse
|
14
|
Chang Y, Noh YH, Suh BS, Kim Y, Sung E, Jung HS, Kim CW, Kwon MJ, Yun KE, Noh JW, Shin H, Cho YK, Ryu S. Bidirectional Association between Nonalcoholic Fatty Liver Disease and Gallstone Disease: A Cohort Study. J Clin Med 2018; 7:jcm7110458. [PMID: 30469392 PMCID: PMC6262563 DOI: 10.3390/jcm7110458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are often found to coexist but the sequential relationship of NAFLD and GD to each other remains controversial. We prospectively evaluated the bidirectional relationship of NAFLD with GD. A cohort study was performed on Korean adults who underwent a health checkup and were followed annually or biennially for a mean of 6.0 years. Fatty liver and gallstones were diagnosed by ultrasound. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The NAFLD severity was determined by non-invasive fibrosis markers. Among 283,446 participants without either gallstones or cholecystectomy at baseline, 6440 participants developed gallstones. Among 219,641 participants without NAFLD at baseline, 49,301 participants developed NAFLD. The multivariable-adjusted hazard ratio (95% confidence interval) for incident gallstone comparing the NAFLD group vs. the non-NAFLD group was 1.26 (1.17–1.35). Increased non-invasive fibrosis markers of NAFLD were positively associated with an increased incidence of gallstones in a graded and dose-responsive manner (p-trend < 0.01). The multivariable-adjusted hazard ratios (95% confidence intervals) for incident NAFLD comparing gallstone and cholecystectomy to no GD were 1.14 (1.07–1.22) and 1.17 (1.03–1.33), respectively. This large-scale cohort study of young and middle-aged individuals demonstrated a bidirectional association between NAFLD and GD. NAFLD and its severity were independently associated with an increased incidence of gallstones, while GD and cholecystectomy were also associated with incident NAFLD. Our findings indicate that the conditions may affect each other, requiring further studies to elucidate the potential mechanisms underlying this association.
Collapse
Affiliation(s)
- Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea.
| | - Yoo-Hun Noh
- Department of Anatomy and Cell Biology, College of Medicine, Chung-Ang University, Seoul 06974, Korea.
| | - Byung-Seong Suh
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
| | - Yejin Kim
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
| | - Eunju Sung
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
| | - Hyun-Suk Jung
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
| | - Chan-Won Kim
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03131, Korea.
| | - Kyung Eun Yun
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
| | - Jin-Won Noh
- Department of Healthcare Management and Institute of Global Healthcare Research, Eulji University, Seongnam 13135, Korea.
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen 9712, The Netherlands.
| | - Hocheol Shin
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
| | - Yong Kyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
- Center for cohort studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea.
| |
Collapse
|
15
|
Lu P, Yang NP, Chang NT, Lai KR, Lin KB, Chan CL. Effect of socioeconomic inequalities on cholecystectomy outcomes: a 10-year population-based analysis. Int J Equity Health 2018; 17:22. [PMID: 29433528 PMCID: PMC5809951 DOI: 10.1186/s12939-018-0739-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP). METHODS A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003-2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21-51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model. RESULTS Analyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78-175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37-130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center. CONCLUSION Patients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery. This result suggested that further interventions in the health care system are necessary to reduce this disparity.
Collapse
Affiliation(s)
- Ping Lu
- School of Economics and Management, Xiamen University of Technology, Xiamen, 361024, China.,Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Nan-Ping Yang
- Department of Surgery, Keelung Hospital, Ministry of Health and Welfare, Keelung, 20148, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - K Robert Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Kai-Biao Lin
- School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
| |
Collapse
|
16
|
Hemminki K, Hemminki O, Försti A, Sundquist K, Sundquist J, Li X. Familial risks for gallstones in the population of Sweden. BMJ Open Gastroenterol 2017; 4:e000188. [PMID: 29333277 PMCID: PMC5759740 DOI: 10.1136/bmjgast-2017-000188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/30/2017] [Accepted: 12/15/2017] [Indexed: 12/17/2022] Open
Abstract
Objectives Gallstone disease (cholelithiasis) has a familial component, but detailed data on the modification of familial risk are lacking. Using nationwide hospital and population records, we aimed to determine detailed familial risks for medically diagnosed gallstone disease. Design Subjects were obtained from the Multigeneration Register, which contains family data on the Swedish population, and patients with gallstone disease were identified from the Hospital Discharge Register (1964-2015) and the Outpatient Register (2001-2015). Standardised incidence ratios (SIRs) were calculated as the ratio of observed to expected number of cases. Results Gallstone disease was diagnosed in 660 732 patients, with an overall incidence of 131 per 100 000 person-years. Familial cases accounted for 36.0% of all patients with gallstone disease. Of these, 50.9% had a parental family history (SIR 1.62), 35.1% had a sibling history (SIR 1.75) and 14.0% had a parental+sibling history (SIR 2.58). Among a total of 54 630 affected siblings, 84.4% were sibling pairs (SIR 1.55). However, the remaining 15.6% of the affected siblings constituted the high-risk group of multiple affected siblings and an SIR >10; these persons accounted for 7.7% of all familial cases. The spousal risk was only slightly increased to 1.18. Conclusions Overall, the results point to the underlying genetic causes for the observed familial clustering, which may involve polygenic gene-environmental interactions for most familial cases but high-risk genes in close to 10% of cases. Family histories should be taken into account in the medical setting and used for counselling of at-risk individuals.
Collapse
Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Helsinki, Finland
| | - Otto Hemminki
- Department of Abdominal Surgery and Urology, Helsinki University Hospital, Helsinki, Finland.,Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Helsinki, Finland
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Helsinki, Finland.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Helsinki, Finland.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Helsinki, Finland
| |
Collapse
|
17
|
Lu P, Chan CL, Yang NP, Chang NT, Lin KB, Lai KR. Outcome comparison between percutaneous cholecystostomy and cholecystectomy: a 10-year population-based analysis. BMC Surg 2017; 17:130. [PMID: 29212485 PMCID: PMC5719669 DOI: 10.1186/s12893-017-0327-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/24/2017] [Indexed: 12/15/2022] Open
Abstract
Background Controversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for PC rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC). Methods We conducted this study by tracking trends in the utilization and outcomes of PC and CCS using longitudinal health research data in Taiwan. Results Analyses were conducted on 236,742 patients, 11,184 of whom had undergone PC and 225,558 of whom had undergone CCS. Average annual percentage changes (AAPCs) from 2003 to 2012 increased significantly by 18.34% each year for PC and by 2.82% each year for CCS. The subset analyzes showed that the mortality rates were far higher in patients underwent PC than in patients underwent CCS in all subgroups, which increased from a minimum of 1.45-fold to a maximum of 34.22-fold. The gap of the mortality rates between PC group and CCS group narrowed as the patients aged and with the seriousness of the diseases increased. Most patients with PC or CCS who died in-hospital or within 30 days after discharge were 70 years of age or older, and a large number of them received a CCI score of at least 1. The AAPCs of the overall mortality rates from 2003 to 2012 decreased by 6.78% each year for PC and by 7.33% each year for CCS. PC was related to a higher rate of cholecystitis recurrence and readmission for complications, but a lower rate of in-hospital complications and routine discharge than CCS, and 36.41% of all patients treated with PC underwent subsequent CCS. Additionally, the patients with PC experienced longer hospital stays and generated higher costs than the patients with CCS. Conclusion Patients who underwent PC demonstrated poorer prognoses than did patients who underwent CCS. The role of PC in the Tokyo guidelines may be overstated; it is not as safe as the Tokyo guidelines have suggested in moderate-grade cholecystitis cases, and it should be limited to only the elderly and sicker patients.
Collapse
Affiliation(s)
- Ping Lu
- School of Economics and Management, Xiamen University of Technology, Xiamen, 361024, China.,Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Nan-Ping Yang
- Department of Surgery, Keelung Hospital, Ministry of Health and Welfare, Keelung, 20147, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Kai-Biao Lin
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan.,School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China
| | - K Robert Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
| |
Collapse
|
18
|
Liu FC, Ting PC, Lin JR, Yu HP. Immunosuppressants and new onset gallstone disease in patients having undergone renal transplantation. Ther Clin Risk Manag 2017; 13:1391-1398. [PMID: 29075123 PMCID: PMC5648321 DOI: 10.2147/tcrm.s144975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There are very few reports describing the development of gallstone disease after renal transplantation (GSDART) in Asia. The aim of this population-based study was to explore the prevalence, predictive factors, and outcomes of newly developed GSDART. The relationship between immunosuppressant and GSDART was also explored. PATIENTS AND METHODS Renal transplantation (RT) recipients were identified from the National Health Insurance Research Database of Taiwan during January 1998-December 2012. In total, 2,630 adult patients, who had neither been diagnosed with gallstone disease (GSD) nor undergone cholecystectomy, were included in this study. These patients underwent follow-up till the diagnosis of GSDART was established. Risk factors and post-RT immunosuppressant treatments were investigated and analyzed using Cox regression analysis. The cumulative mortality in patients with and without GSDART was also evaluated. RESULTS The final dataset comprised 143 patients who developed GSDART and 2,487 patients who had not been diagnosed with GSDART during the follow-up period. The prevalence of GSDART was 5.4%. On performing univariate analysis, age (p=0.0276) and certain immunosuppressant administrations were identified as significant risk factors for GSDART. After adjusting for age, multivariable analysis showed that everolimus (adjusted hazard ratio 0.287, p=0.0013) was independently associated with the development of GSDART. The overall mortality rate (6.99%, p=0.0341) was significantly decreased in the GSDART group. CONCLUSION Increased age was the most consistent risk factor for GSD, and everolimus-based immunotherapy indicated a decreased incidence of GSDART in RT recipients. The long-term mortality rate was significantly decreased in patients with GSDART.
Collapse
Affiliation(s)
- Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University
| | - Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University
| |
Collapse
|
19
|
Liang TJ, Liu SI, Chen YC, Chang PM, Huang WC, Chang HT, Chen IS. Analysis of gallstone disease after gastric cancer surgery. Gastric Cancer 2017; 20:895-903. [PMID: 28154944 DOI: 10.1007/s10120-017-0698-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence rate of newly developed gallstone disease after gastrectomy for gastric cancer is thought to be higher than that in the general population. However, the presentation and management of these gallstones remain under debate, and the role of prophylactic cholecystectomy remains questionable. METHODS Data on adult patients who were diagnosed with gastric cancer and received gastrectomy between 2000 and 2011 were extracted from the Taiwan National Health Insurance Research Database. A patient was excluded if he or she had gallstone disease or received cholecystectomy before the index date. The incidence of newly developed gallstone disease and its subsequent management were recorded. Data were analyzed to evaluate the factors associated with gallstone development and treatment options. RESULTS A total of 17,325 gastric cancer patients who underwent gastrectomy were eligible for analysis. During the follow-up period (mean 4.1 years; median, 2.9 years), 1280 (7.4%) patients developed gallstone disease and 560 (3.2%) patients subsequently underwent cholecystectomy. The in-hospital mortality for cholecystectomy was 1.8% (10/560). Development of gallstone disease was associated with older age, total gastrectomy, duodenal exclusion, diabetes, cirrhosis, and more comorbidities. Factors associated with the use of cholecystectomy to treat gallstone disease included younger age, fewer comorbidities, medical center admission, and presentation as cholecystitis. CONCLUSIONS Although few patients required further gallbladder removal after gastrectomy for gastric malignancy, the increased mortality rate for subsequent cholecystectomy was worth noting. The decision to undergo prophylactic cholecystectomy might be individualized based upon patient characteristics and the surgeon's discretion.
Collapse
Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chia Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Po-Min Chang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Wei-Chun Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hong-Tai Chang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.
| |
Collapse
|
20
|
Lin WC, Chang CW, Chu CH. Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients. Kaohsiung J Med Sci 2016; 32:518-525. [DOI: 10.1016/j.kjms.2016.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/21/2016] [Accepted: 08/11/2016] [Indexed: 01/11/2023] Open
|
21
|
Liu CM, Chung CL, Hsu CT, Song MZ, Chen CC, Li CY. Impact of diabetes mellitus on cholecystectomy rate: A population-based follow-up study. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
22
|
Tsai MC, Chen CH, Lee HC, Lin HC, Lee CZ. Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones. PLoS One 2015; 10:e0129962. [PMID: 26053886 PMCID: PMC4460135 DOI: 10.1371/journal.pone.0129962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/13/2015] [Indexed: 02/06/2023] Open
Abstract
Background Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database. Methods Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy. Results Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient’s sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02–2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08–2.41) for patients who underwent cholecystectomy compared to those who did not. Conclusions There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.
Collapse
Affiliation(s)
- Ming-Chieh Tsai
- Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chao-Hung Chen
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsin-Chien Lee
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cha-Ze Lee
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
23
|
Shen TC, Lai HC, Huang YJ, Lin CL, Sung FC, Kao CH. The risk of depression in patients with cholelithiasis before and after cholecystectomy: a population-based cohort study. Medicine (Baltimore) 2015; 94:e631. [PMID: 25761193 PMCID: PMC4602463 DOI: 10.1097/md.0000000000000631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The association between cholelithiasis and depression remains unclear. We examined the risk of depression in patients with cholelithiasis. From the National Health Insurance population claims data of Taiwan, we identified 14071 newly diagnosed cholelithiasis patients (4969 symptomatic and 9102 asymptomatic) from 2000 to 2010. For each cholelithiasis patient, 4 persons without cholelithiasis were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosis year. Both cohorts were followed up until the end of 2011 to monitor the occurrence of depression. Adjusted hazard ratios (aHRs) of depression were estimated using the Cox proportional hazards model after controlling for age, sex and comorbidities. The overall incidence rates of depression were 1.87- and 1.83-fold greater in the symptomatic and asymptomatic cholelithiasis subcohorts than in the control cohort (incidence, 10.1 and 9.96 vs 5.43 per 1000 person-years, respectively). The multivariable Cox proportional hazards regression analysis revealed higher variable-specific aHRs in women than in men, in younger patients than in older patients, and in those without comorbidities than in those with any comorbidity. Cholecystectomy reduced the hazard of developing depression with aHRs of 0.79 (95% confidence interval [CI] 0.62-0.99) for symptomatic cholelithiasis patients and 0.76 (95% CI 0.60-0.96) for asymptomatic patients. Patients with cholelithiasis are at a higher risk of developing depression than the general population. Patients could be benefited from cholecystectomy and have the hazard of developing depression significantly reduced.
Collapse
Affiliation(s)
- Te-Chun Shen
- From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University (T-CS, H-CL, F-CS, C-HK); Division of Pulmonary and Critical Care Medicine (T-CS); Division of Gastroenterology and Hepatology, Department of Internal Medicine (H-CL); Department of Psychiatry (Y-JH); Management Office for Health Data (C-LL); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
| | | | | | | | | | | |
Collapse
|
24
|
Klahan S, Kuo CN, Chien SC, Lin YW, Lin CY, Lin CH, Chang WC, Lin CI, Hung KS, Chang WP. Osteoporosis increases subsequent risk of gallstone: a nationwide population-based cohort study in Taiwan. BMC Gastroenterol 2014; 14:192. [PMID: 25404001 PMCID: PMC4247648 DOI: 10.1186/s12876-014-0192-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/27/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Osteopontin (OPN) is a pro-inflammatory cytokine which is expressed in various tissues. It participates in the bone remodeling process and stimulates bone resorption by osteoclasts. It is also a core protein of cholesterol gallstones. We hypothesized osteoporotic patients might have higher risk in developing gallstones and conducted a population-based study to examine the risk of developing gallstone in osteoporotic patients in Taiwan. METHODS A total of 1,638 patients diagnosed with osteoporosis between 2003 and 2005 were identified in the National Health Insurance Research Database. A comparison cohort without osteoporosis (n =6,552) was randomly matched to each osteoporosis patient at a ratio of 4: 1 based on age and sex. A Cox proportional-hazards regression analysis was performed to evaluate the 5-year gallstone-free survival rates for the 2 cohorts. RESULTS During the 5-year follow-up period, 114 and 311 cases of gallstone occurred in the osteoporosis and comparison cohorts, respectively. After adjusting for the confounders, the Cox regression analysis of the risk of gallstone in the osteoporosis and comparison cohorts yielded a hazard ratio of 1.35 (95% confidence interval: 1.07 - 1.69; p < 0 .01). CONCLUSION Patients with osteoporosis in Taiwan have a higher risk of developing gallstone than the general population.
Collapse
Affiliation(s)
- Sukhontip Klahan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Chun-Nan Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Department of Pharmacy, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
| | - Shu-Chen Chien
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Yea-Wen Lin
- Department of Healthcare Management, Yuanpei University of Medical Technology, HsinChu, Taiwan.
| | - Chun-Yi Lin
- Department of Healthcare Management, Yuanpei University of Medical Technology, HsinChu, Taiwan.
| | - Chia-Hsien Lin
- Department of Health Industry Management, Kainan University, Taoyuan, Taiwan.
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Department of Pharmacy, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. .,Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Pharmacognosy, Taipei Medical University, Taipei, Taiwan.
| | - Ching-I Lin
- Department of Nutrition and Health Sciences, Kainan University, Taoyuan, Taiwan.
| | - Kuo-Sheng Hung
- Department of Neurosurgery, Clinical Research Center, Graduate Institute of Injury Prevention and Control, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan. .,Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan.
| | - Wei-Pin Chang
- Department of Healthcare Management, Yuanpei University of Medical Technology, HsinChu, Taiwan.
| |
Collapse
|
25
|
Cholelithiasis and risk of pancreatic cancer: systematic review and meta-analysis of 21 observational studies. Cancer Causes Control 2014; 25:1543-51. [DOI: 10.1007/s10552-014-0458-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/06/2014] [Indexed: 12/31/2022]
|
26
|
Chen YK, Yeh JH, Lin CL, Peng CL, Sung FC, Hwang IM, Kao CH. Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study. J Gastroenterol 2014; 49:923-31. [PMID: 23807230 DOI: 10.1007/s00535-013-0846-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/03/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examined the association of cholelithiasis post-cholecystectomy with subsequent cancers and evaluated the risk of cancer in patients with both cholelithiasis and cholecystectomy. METHODS The Taiwanese National Health Insurance Research Database was used to identify 15545 newly diagnosed cholelithiasis patients from 2000 to 2010, and 62180 frequency-matched non-cholelithiasis patients. A total of 5850 (37.6 %) with cholelithiasis patients received a cholecystectomy. The risk of developing cancer after cholecystectomy was measured using the Cox proportional-hazards model. RESULTS The incidence of developing cancer in the cholelithiasis cohort was 1.52-fold higher than that in the comparison cohort (p < 0.001). Compared with patients aged 20-34 years, patients in older age groups had a higher risk of developing cancer. The hazard ratio (HR) for developing gallbladder, extrahepatic bile duct, pancreatic, liver, stomach, and colorectal cancer was 59.3, 10.7, 3.12, 1.90, 1.71, and 1.36-fold higher for patients with cholelithiasis, respectively. After a cholecystectomy, the HR for developing stomach and colorectal cancer was 1.81-fold and 1.56-fold, respectively. The incidence rate ratio was higher for the first 5 years and over 5 years (5.05 and 4.46, respectively) (95 % confidence interval 4.73-5.39 and 4.11-4.84, respectively) in proximal colon and stomach cancer patients with cholecystectomies. CONCLUSIONS Cholelithiasis patients have a higher risk of gastrointestinal cancer, particularly of gallbladder and extrahepatic bile duct cancer. Post-cholecystectomy patients have a risk of colorectal and stomach cancer within the first 5 years and persisting after 5 years, respectively. This paper proposes strategies for preventing gastrointestinal cancer.
Collapse
Affiliation(s)
- Yen-Kung Chen
- Department of Nuclear Medicine and PET Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
27
|
Vogtmann E, Shu XO, Li HL, Chow WH, Yang G, Ji BT, Cai H, Yu C, Gao YT, Zheng W, Xiang YB. Cholelithiasis and the risk of liver cancer: results from cohort studies of 134,546 Chinese men and women. J Epidemiol Community Health 2014; 68:565-70. [PMID: 24574318 DOI: 10.1136/jech-2013-203503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cholelithiasis and cholecystectomy have been proposed as risk factors for liver cancer, but findings have been inconsistent. We assessed this association using data from the Shanghai Women's and Men's Health Studies. METHODS History of cholelithiasis and cholecystectomy were reported at baseline and follow-up interviews, and liver cancer diagnoses were ascertained from the Shanghai Cancer Registry and Vital Statistics Unit. Adjusted hazard ratios (aHRs) and 95% CIs were calculated after adjustment for potential confounders. RESULTS A history of cholelithiasis and cholecystectomy was reported by 9.5% and 3.6% of participants at baseline, respectively. After a total of 859,882 person-years of follow-up for women and 391,093 for men, incident liver cancer was detected in 160 women and 252 men. A positive association was observed between a history of cholelithiasis or cholecystectomy and liver cancer in men (aHR 1.46; 95% CI 1.02 to 2.07) and women (aHR 1.55; 95% CI 1.06 to 2.26). Similar results were observed for cholelithiasis only, but cholecystectomy did not reach statistical significance. There was no strong evidence for detection bias of liver cancer due to cholelithiasis or cholecystectomy. CONCLUSIONS Our study suggests that cholelithiasis and possibly cholecystectomy may increase the risk of liver cancer.
Collapse
Affiliation(s)
- Emily Vogtmann
- State Key Laboratory of Oncogene and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, , Shanghai, P R China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Olaiya MT, Chiou HY, Jeng JS, Lien LM, Hsieh FI. Significantly increased risk of cardiovascular disease among patients with gallstone disease: a population-based cohort study. PLoS One 2013; 8:e76448. [PMID: 24098504 PMCID: PMC3789705 DOI: 10.1371/journal.pone.0076448] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/26/2013] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To investigate whether gallstone disease (GD) increases the risk of developing cardiovascular disease (CVD) in a large population-based cohort. METHODS A study population including 6,981 patients with GD was identified from The Taiwan National Health Insurance Research Database between 2004 and 2005. GD patients were defined as patients with principal discharge diagnoses of cholelithiasis using the ICD-9-CM code 574. 27,924 patients without GD were randomly selected and matched for age and gender. All patients were followed for 6 years or until diagnosis for CVD. Cox proportional hazards regression model was used to assess the risk of developing CVD with adjustment for age, gender and co-morbid conditions. RESULTS During the six years follow-up period, 935 patients with GD and 2,758 patients without GD developed CVD. Patients with GD had an elevated risk of CVD (HR, 1.32; 95% CI, 1.22-1.43) when compared with those without GD. Similar relationship was observed when CVD was categorized i.e. stroke (HR, 1.15; 95% CI, 1.01-1.32), coronary heart disease (HR, 1.42; 95% CI, 1.28-1.58) and heart failure (HR, 1.31; 95% CI, 1.00-1.73). When GD was classified according to the level of severity, using patients without GD as reference, the risks of CVD were elevated in patients with non-severe GD (HR, 1.34; 95% CI, 1.24-1.46) as well as those with severe GD (HR, 1.20, 95% CI, 1.02-1.40), after adjusting for age, gender and comorbidities. In age-stratified analysis, patients aged 18-40 years with GD were at higher risk of developing CVD (HR, 1.42; 95% CI, 1.09-1.84) than older GD patients. CONCLUSION This study found an increased risk of CVD in patients diagnosed with GD. The excess risk was particularly high in younger GD patients. Prevention of GD could help reduce the risk of developing CVD, and the better effect could be achieved for the younger age groups.
Collapse
Affiliation(s)
| | - Hung-Yi Chiou
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jiann-Shing Jeng
- The Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan
| | - Fang-I Hsieh
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
29
|
The clinical investigation of disparity of utility values associated with gallstone disease: a pilot study. Gastroenterol Res Pract 2013; 2013:216957. [PMID: 24101923 PMCID: PMC3786525 DOI: 10.1155/2013/216957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023] Open
Abstract
Purpose. The utility evaluation was an effective method to incorporate all of the contributing variables for multiple diseases into one outcome measure. A cross-sectional study was conducted to assess the utility values associated with varying states of gallstone disease among outpatient clinics participants at a teaching hospital in Taipei, Taiwan. Methods. The utility values were measured by using time trade-off method. A total of 120 outpatient clinics participants (30 subjects with no gallstone disease, 30 subjects with single stone, 30 subjects with multiple stones, and 30 subjects with cholecystectomy) evaluated utility values from January 1, 2006 to December 31, 2006. The diagnosis of gallstone disease was performed by a panel of specialists using ultrasound sonography. Results. The overall mean utility value was 0.89 ± 0.13 (95% CI: 0.87-0.91) indicating that study participants were willing to trade about 11% (95% CI: 9-13%) of their remaining life in return for being free of gallstone disease perpetually. The significant associated factors of utility values based on the multiple linear regression analysis were older age and different degrees of gallstone disease. Conclusion. Our results found that in addition to older age, multiple stones and cholecystectomy could influence utility values from the patient's preference-based viewpoint.
Collapse
|
30
|
Shih SC, Yang HW, Chang TY, Wang HY, Hu KC, Chang CW, Chang CW, Hung CY, Lin M, Chan HW, Lin WS, Chang SC, Lee YJ. Gender-specific association of the interleukin 18 gene with symptomatic gallstone disease. J Gastroenterol Hepatol 2013; 28:744-9. [PMID: 23302036 DOI: 10.1111/jgh.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Symptomatic gallstone disease (SGSD) induced several inflammatory responses and affected extrahepatic bile ducts. Although the pathology and environmental risk factors of gallstone disease are well documented, immune or inflammatory responses in SGSD development are still inconclusive. Interleukin 18 (IL18) is a pro-inflammatory cytokine that plays an important role in immune, infectious, and inflammatory diseases because of the induction of interferon-γ. In this study, we investigated whether polymorphisms of the IL18 gene were associated with SGSD susceptibility. METHODS Genomic DNA was isolated from the whole blood samples of 445 patients with SGSD and 1121 gallstone-free controls. The IL18 rs549908T>G, rs5744247C>G, rs187238G>C, rs1946518T>G, and rs360719A>G polymorphisms were genotyped using predeveloped TaqMan allelic discrimination assay. RESULTS We found IL18 rs5744247G allele conferred protection against SGSD in female patients (odds ratio = 0.75, corrected P-value = 0.015). Haplotype analysis revealed that TGGTA protected females from SGSD development (odds ratio = 0.75, corrected P-value = 0.02). CONCLUSIONS Based on our findings, IL18 rs5744247C>G polymorphism could be a potential genetic marker to predict SGSD susceptibility in Han Chinese women.
Collapse
Affiliation(s)
- Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kao WY, Hwang CY, Su CW, Chang YT, Luo JC, Hou MC, Lin HC, Lee FY, Wu JC. Risk of hepato-biliary cancer after cholecystectomy: a nationwide cohort study. J Gastrointest Surg 2013. [PMID: 23188223 DOI: 10.1007/s11605-012-2090-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Epidemiologic studies have identified cholecystectomy as a possible risk factor for cancers in Western countries. The aim of this study was to estimate the risk of hepato-biliary cancer after cholecystectomy in Taiwan. METHODS Based on the Taiwan National Health Insurance Research Database, 2,590 cholecystectomized patients without prior cancers in the period 1996-2008 were identified from a cohort dataset of 1,000,000 randomly sampled individuals. The standard incidence ratio (SIR) of each cancer was calculated. RESULTS After a median follow-up of 4.82 years, 67 liver cancer and 17 biliary tract cancer patients were diagnosed. Patients who received cholecystectomy had higher risks of liver cancer (SIR, 3.29) and biliary tract cancer (SIR, 8.50). Cholecystectomized patients aged ≤60 years had higher risks of liver cancer (SIR, 11.14) and biliary tract cancer (SIR, 55.86) compared to those aged >60 years (SIR, 2.31 and 5.67). Female cholecystectomized patients had higher risks of liver cancer (SIR, 4.18) and biliary tract cancer (SIR, 10.56) than males (SIR, 2.96 and 7.26). Cholecystectomized patients with cirrhosis had higher SIR of liver cancer than patients without cirrhosis (SIR, 33.84 vs. 1.41). CONCLUSIONS Cholecystectomy may be associated with an increased risk of hepato-biliary cancer. Further and regular surveillance should be performed on such patients.
Collapse
Affiliation(s)
- Wei-Yu Kao
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Chen LY, Qiao QH, Zhang SC, Chen YH, Chao GQ, Fang LZ. Metabolic syndrome and gallstone disease. World J Gastroenterol 2012; 18:4215-20. [PMID: 22919256 PMCID: PMC3422804 DOI: 10.3748/wjg.v18.i31.4215] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 05/18/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the association between metabolic syndrome (MetS) and the development of gallstone disease (GSD).
METHODS: A cross-sectional study was conducted in 7570 subjects (4978 men aged 45.0 ± 8.8 years, and 2592 women aged 45.3 ± 9.5 years) enrolled from the physical check-up center of the hospital. The subjects included 918 patients with gallstones (653 men and 265 women) and 6652 healthy controls (4325 men and 2327 women) without gallstones. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG) and serum lipids and lipoproteins levels were measured. Colorimetric method was used to measure cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Dextrose oxidizing enzyme method was used to measure FPG. Subjects were asked to complete a questionnaire that enquired about the information on demographic data, age, gender, histories of diabetes mellitus, hypertension, and chronic liver disease and so on. Metabolic syndrome was diagnosed according to the Adult Treatment Panel III (ATP III) criteria. Gallstones were defined by the presence of strong intraluminal echoes that were gravity-dependent or attenuated ultrasound transmission.
RESULTS: Among the 7570 subjects, the prevalence of the gallstone disease was 12.1% (13.1% in men and 10.2% in women). BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose and serum triglyceride (TG) in cases group were higher than in controls, while serum high-density lipid was lower than in controls. There were significant differences in the waist circumference, blood pressure, FPG and TG between cases and controls. In an age-adjusted logistic regression model, metabolic syndrome was associated with gallstone disease. The age-adjusted odds ratio of MetS for GSD in men was 1.29 [95% confidence interval (CI), 1.09-1.52; P = 0.0030], and 1.68 (95% CI, 1.26-2.25; P = 0.0004) in women; the overall age-adjusted odds ratio of MetS for GSD was 1.42 (95% CI, 1.23-1.64; P < 0.0001). The men with more metabolic disorders had a higher prevalence of gallstone disease, the trend had statistical significance (P < 0.0001). The presence of 5 components of the MetS increased the risk of gallstone disease by 3.4 times (P < 0.0001). The prevalence of GSD in women who had 5 components of MetS was 5 times higher than in those without MetS component. The more the components of MetS, the higher the prevalence of GSD (P < 0.0001). The presence of 5 components of the MetS increased the risk of gallstone disease by 4.0 times.
CONCLUSION: GSD appears to be strongly associated with MetS, and the more the components of MetS, the higher the prevalence of GSD.
Collapse
|
33
|
Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas 2012; 41:696-702. [PMID: 22699142 DOI: 10.1097/mpa.0b013e31823db941] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to describe a 10-year epidemiological trend of patients with first-attack acute pancreatitis (AP) in Taiwan. METHODS We analyzed 107,349 patients with first-attack AP from the Taiwan National Health Insurance Research Database between 2000 and 2009. Severe cases were defined according to a modified Atlanta classification. Incidence rates were standardized by direct method. RESULTS During the study period, the median age of the patients increased from 49 to 55 years and the proportion of men decreased from 66.8% to 62.3%. The averaged annual incidence of first-attack AP was estimated at 36.9 per 100,000 persons and changed only slightly. Stratified analyses showed that the incidence increased in children (<15 years), elderly people (≥ 65 years), and patients with biliary cause, but decreased in young to middle-aged men (15-64 years). The prevalence of severe cases increased from 21.0% to 22.3%, which was mainly caused by an increase of acute organ dysfunction (from 9.7% to 14.1%). Despite that, hospital mortality decreased from 4.3% to 3.3% for all cases and from 18.5% to 13.3% for severe ones. CONCLUSIONS The overall incidence of first-attack AP changed slightly in Taiwan, which differs from the increasing trend observed in most Western countries. Although more patients had severe attacks in recent years, hospital mortality declined.
Collapse
|
34
|
Su Y, Dai Y, Lin Y, Gao X, Han Y, Zhao B. Serum organochlorine pesticide residues and risk of gallstone disease: a case-control study in Xiamen. Ann Epidemiol 2012; 22:592-7. [PMID: 22695391 DOI: 10.1016/j.annepidem.2012.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate the association between serum organochlorine pesticide residues and risk of gallstone disease. METHODS A 1:1, pair-matched, case-control study was designed. Data from 150 patients with gallstones diagnosed by abdominal ultrasonography at a single hospital from June 2009 to June 2010 were collected. A total of 150 patients without gallstones during the same period at the same hospital were recruited as the control group. Capillary gas chromatography was employed to measure the serum concentrations of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) residues. Multiple-factor conditional logistic regression analysis was conducted to estimate the relative risk of gallstones in relation to organochlorine pesticide residues in serum. RESULTS The percentages of p,p'-DDD and o,p'-DDT in serum of patients were significantly higher than those in serum of controls. The p,p'-DDE, α-HCH, and δ-HCH residues in serum of patients were also significantly increased compared with those in serum of controls. Multiple-factor conditional logistic regression analysis showed that high levels of p,p'-DDE and p,p'-DDT residues were risk factors for gallstone disease. CONCLUSIONS A high level of organochlorine pesticide residues in serum is a potential risk factor for gallstone disease, which suggests that environmental exposure to organochlorine pesticides should be evaluated with respect to gallstone formation.
Collapse
Affiliation(s)
- Yanhua Su
- School of Public Health, Xiamen University, Fujian, China
| | | | | | | | | | | |
Collapse
|
35
|
Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev 2012:CD009779. [PMID: 22592743 DOI: 10.1002/14651858.cd009779.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute gallstone pancreatitis remains controversial. A number of clinical trials and meta-analyses have provided conflicting evidence. OBJECTIVES To systematically review evidence from randomized controlled trials (RCTs) assessing the clinical effectiveness and safety of the early routine ERCP strategy compared to the early conservative management with or without selective use of ERCP strategy, based on all important, clinically relevant and standardized outcomes including mortality, local and systemic complications as defined by the Atlanta Classification (Bradley 1993) and by authors of the primary study, and ERCP-related complications in unselected patients with acute gallstone pancreatitis. SEARCH METHODS We searched the CENTRAL (The Cochrane Library), MEDLINE, EMBASE, and LILACS databases and major conference proceedings up to January 2012, using the Cochrane Upper Gastrointestinal and Pancreatic Diseases model with no language restrictions. SELECTION CRITERIA RCTs comparing the early routine ERCP strategy versus the early conservative management with or without selective use of ERCP strategy in patients with suspected acute gallstone pancreatitis. We included studies in which the population with acute gallstone pancreatitis was a subgroup within a larger group of patients. We only included studies involving only a selected subgroup of patients with acute gallstone pancreatitis (actual severe pancreatitis) in subgroup analyses. DATA COLLECTION AND ANALYSIS Two review authors conducted study selection, data extraction, and methodological quality assessment independently. Using intention-to-treat analysis with random-effects models, we combined dichotomous data to obtain risk ratios (RR) with 95% confidence intervals (CI). We assessed heterogeneity using the Chi² test and I² statistic. To explore sources of heterogeneity, we conducted a priori subgroup analyses according to predicted severity of pancreatitis, cholangitis, biliary obstruction, time to ERCP in routine ERCP strategy, use of selective ERCP in conservative management strategy, and risk of bias. To assess the robustness of our results, we carried out sensitivity analyses using different summary statistics (RR versus odds ratio (OR)) and meta-analytic models (fixed versus random-effects), and per-protocol analysis. We performed influence analysis by exclusion of each study. MAIN RESULTS Five RCTs comprising 644 participants were included in the main analyses. Two additional RCTs, comprising only patients with actual severe acute gallstone pancreatitis, were included only in subgroup analyses. There was statistical heterogeneity among trials for mortality, but not for other outcomes. In unselected patients with acute gallstone pancreatitis, there were no statistically significant differences between the two strategies in mortality (RR 0.74, 95% CI 0.18 to 3.03), local and systemic complications as defined by the Atlanta Classification (RR 0.86, 95% CI 0.52 to 1.43; and RR 0.59, 95% CI 0.31 to 1.11 respectively) and by authors of the primary study (RR 0.80, 95% CI 0.51 to 1.26; and RR 0.76, 95% CI 0.53 to 1.09 respectively). The results were robust to sensitivity and influence analyses except for systemic complications as defined by the Atlanta Classification. There was no evidence to suggest that the results were dependent on predicted severity of pancreatitis. Among trials that included patients with cholangitis, the early routine ERCP strategy significantly reduced mortality (RR 0.20, 95% CI 0.06 to 0.68), local and systemic complications as defined by the Atlanta Classification (RR 0.45, 95% CI 0.20 to 0.99; and RR 0.37, 95% CI 0.18 to 0.78 respectively) and by authors of the primary study (RR 0.50, 95% CI 0.29 to 0.87; and RR 0.41, 95% CI 0.21 to 0.82 respectively). Among trials that included patients with biliary obstruction, the early routine ERCP strategy was associated with a significant reduction in local complications as defined by authors of the primary study (RR 0.54, 95% CI 0.32 to 0.91), and a non-significant trend towards reduction of local and systemic complications as defined by the Atlanta Classification (RR 0.53, 95% CI 0.26 to 1.07; and RR 0.56, 95% CI 0.30 to 1.02 respectively) and systemic complications as defined by authors of the primary study (RR 0.59, 95% CI 0.35 to 1.01). ERCP complications were infrequent. AUTHORS' CONCLUSIONS In patients with acute gallstone pancreatitis, there is no evidence that early routine ERCP significantly affects mortality, and local or systemic complications of pancreatitis, regardless of predicted severity. Our results, however, provide support for current recommendations that early ERCP should be considered in patients with co-existing cholangitis or biliary obstruction.
Collapse
Affiliation(s)
- Frances Tse
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada.
| | | |
Collapse
|
36
|
Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009779] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Liu CM, Hsu CT, Li CY, Chen CC, Liu ML, Liu JH. A population-based cohort study of symptomatic gallstone disease in diabetic patients. World J Gastroenterol 2012; 18:1652-9. [PMID: 22529695 PMCID: PMC3325532 DOI: 10.3748/wjg.v18.i14.1652] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/08/2011] [Accepted: 12/16/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of gallstone disease (GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.
METHODS: The study was conducted by analyzing the National Health Research Institutes (NHRI) dataset of ambulatory care patients, inpatient claims, and the updated registry of beneficiaries from 2000 to 2008. A total of 615 532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000. Age- and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database (n = 614 871). The incidence densities of symptomatic GSD were estimated according to the subjects’ diabetic status. The distributions of age, gender, occupation, income, and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models. Differences between the rates of selected comorbidities were also assessed in the two groups.
RESULTS: Overall, 60 734 diabetic patients and 48 116 control patients developed symptomatic GSD and underwent operations, resulting in cumulative operation rates of 9.87% and 7.83%, respectively. The age and gender distributions of both groups were similar, with a mean age of 60 years and a predominance of females. The diabetic group had a significantly higher prevalence of all comorbidities of interest. A higher incidence of symptomatic GSD was observed in females than in males in both groups. In the control group, females under the age of 64 had a significantly higher incidence of GSD than the corresponding males, but this difference was reduced with increasing age. The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years, respectively. Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group (12.35 vs 8.75 cases per 1000 person-years).
CONCLUSION: The association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.
Collapse
|
38
|
Visceral surgeon and intraoperative cholangiography: Survey about French Wild West surgeons. J Visc Surg 2011; 148:e385-91. [PMID: 22019838 DOI: 10.1016/j.jviscsurg.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cholecystectomy is one of the most common abdominal surgical procedures. No formal agreement has been reached about the routine practice of intraoperative cholangiography (IOC). The purpose of this survey was to describe the practices and the opinions of surgeons in western France. A survey was conducted among 300 visceral surgeons practicing in western France who were asked to respond to a questionnaire with objective and subjective items. One hundred forty-eight answers were interpretable. Among these 148 surgeons, 125 (83.4%) performed IOC routinely (IOCr group) and 23 (15.4%) selectively (IOCs group). Mean age of responding surgeons was 49.3 years. Groups IOCr and IOCs were not significantly different concerning surgical experience. Surgeons in both groups responded that IOC effectively screens for intraoperative bile duct injury. In our survey, routine practice of IOC was more common than reported by our English-speaking colleagues. The routine users responded that IOC can screen for intraoperative bile duct injury or choledocholithiasis. The selective users responded that IOC has its own morbidity. IOC is commonly performed in France during laparoscopic cholecystectomy. Although it may not be indispensable, it allows rapid screening for intraoperative bile duct injury. It also provides documented proof of good surgical practice in the event of a litigation claim after bile duct injury.
Collapse
|
39
|
Hung SC, Liao KF, Lai SW, Li CI, Chen WC. Risk factors associated with symptomatic cholelithiasis in Taiwan: a population-based study. BMC Gastroenterol 2011; 11:111. [PMID: 21999925 PMCID: PMC3215644 DOI: 10.1186/1471-230x-11-111] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/17/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cholelithiasis has become a major health problem in Taiwan. The predominant type of gallstone found in Asian populations differs from that in the West, indicating possible differences in the etiology and risk factors for cholelithiasis. The aim of this study is to investigate the risk factors for cholelithiasis using data representative of the general population. METHODS We performed a population-based, case-control study in which we analyzed medical data for 3725 patients newly diagnosed with cholelithiasis and 11175 gender- and age-matched controls with no history of cholelithiasis, using information obtained from the 2005 Registry for Beneficiaries of the National Health Insurance Research Database. Coexisting medical conditions were included in the analysis. Relative risks were estimated by adjusted odds ratio (OR) and 95% confidence interval (CI) using a multivariate logistic regression analysis. RESULTS After controlling for the other covariates, multivariate logistic regression analysis identified the following as risk factors for cholelithiasis (in descending order of contribution): Among all patients - hepatitis C (OR = 2.78), cirrhosis (OR = 2.47), hepatitis B (OR = 2.00), obesity (OR = 1.89), and hyperlipidemia (OR = 1.54); Among women - hepatitis C (OR = 3.05), cirrhosis (OR = 1.92), obesity (OR = 1.91), menopause (OR = 1.61), hepatitis B (OR = 1.54), and hyperlipidemia (OR = 1.49). Diabetes mellitus appeared to have a marked influence on the development of cholelithiasis but was not identified as a significant independent risk factor for cholelithiasis. CONCLUSIONS The risk factors for cholelithiasis were obesity, hyperlipidemia, hepatitis B infection, hepatitis C infection, and cirrhosis in both genders, and menopause in females. Despite differences in the predominate type of gallstone in Asian versus Western populations, we identified no unique risk factors among the population of Taiwan.
Collapse
Affiliation(s)
- Shih-Chang Hung
- Department of Emergency Medicine, Nantou Hospital, Nantou, 540, Taiwan
| | | | | | | | | |
Collapse
|
40
|
Shih SC, Yang HW, Chang TY, Hu KC, Chang SC, Lin CL, Hung CY, Wang HY, Lin M, Lee YJ. Investigation of cytotoxic T-lymphocyte-associated protein 4 gene polymorphisms in symptomatic gallstone disease. Hum Immunol 2011; 72:355-8. [PMID: 21277929 DOI: 10.1016/j.humimm.2011.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 12/22/2010] [Accepted: 01/13/2011] [Indexed: 12/14/2022]
Abstract
Gallstone disease (GSD), which is increasingly prevalent in Taiwan, develops through a complex process involving genetic, environmental, and immune factors. Cytotoxic T-lymphocyte-associated protein 4 (CTLA4) limits T-cell proliferation. The present study looked for associations between symptomatic GSD and polymorphisms of the CTLA4 gene. For this case-control cross-sectional study among Taiwanese, 275 patients with symptomatic GSD and 852 controls were enrolled. Genotyping of CTLA4-318 C/T, +49 A/G, and CT60 A/G single nucleotide polymorphisms (SNPs) was performed by polymerase chain reaction-restriction fragment length polymorphism. The genotype, allele, carrier, and haplotype frequencies were calculated by direct counting or with Haploview 4.1 software. Genotype, allele, carrier, and haplotype frequencies of the CTLA4 SNPs studied were equally distributed in symptomatic GSD patients and controls. No significant associations between symptomatic GSD and these 3 SNPs were observed. Our data suggest that CTLA4-318 C/T, +49 A/G, and CT60 A/G SNPs do not confer increased susceptibility to symptomatic GSD.
Collapse
Affiliation(s)
- Shou-Chuan Shih
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|