Increased Risk of Major Depressive Disorder After Cholecystectomy: A Nationwide Population-Based Cohort Study in Korea

Endoscopic retrograde cholangiopancreatography combined with extracorporeal shock wave lithotripsy for the removal of large gallbladder stones: a pilot study

BACKGROUND

Endoscopic gallbladder-preserving cholecystolithotomy (EGPC) has become an alternative option for treating cholecystolithiasis. However, developing a new method of EGPC in which the gallbladder wall is not damaged remains a challenge. This study introduced a new EGPC method called endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL), which preserves the integrity of the gallbladder wall in the treatment of cholecystolithiasis complicated with choledocholithiasis.

METHODS

In total, six patients (aged 23-72 years, 3 males and 3 females, Han ethnicity) who had large gallbladder stones (diameter ≥ 1 cm) complicated with common bile duct (CBD) stones and who underwent ERCP combined with ESWL at the First Affiliated Hospital of Nanchang University from July 2022 to December 2022 were enrolled. The patients' clinical characteristics, endoscopic treatment and follow-up data were analyzed. A paired t test was performed to compare the differences in the main serological indicators before and after EGPC.

RESULTS

Of the six patients, five completed EGPC, and one failed due to intolerable abdominal pain during ESWL and was subsequently transferred to surgery. With respect to post-EGPC adverse events, one patient developed mild post-ERCP pancreatitis, and no other adverse events occurred. Both the technical success rate and clinical success rate of ERCP combined with ESWL were 83.3% and the incidence of adverse events was 16.7%. The six patients were followed up for an average of 24 months, during which only one patient experienced a recurrence of gallbladder stones at the 3-month follow-up, but no gallbladder stones were found at the 6-month follow-up after oral administration of ursodeoxycholic acid.

CONCLUSIONS

ERCP combined with ESWL is a potentially safe and effective treatment for large gallbladder stones.

TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry site. [Registration number: ChiCTR2200060927 ( http://www.chictr.org.cn/ ); registration date: June 14, 2022].

Cholecystectomy Increases the Risk of Chronic Kidney Disease: A Nationwide Longitudinal Cohort Study

Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney disease (CKD) using a nationwide longitudinal cohort. Methods: Participants aged ≥20 years with cholecystectomy between 2010 and 2014 (n = 116,748) and age- and sex-matched control participants without cholecystectomy (n = 116,748) were analyzed using the Korea National Health Insurance Service data. The adjusted hazard ratios (aHRs) were calculated for incident CKD in the cholecystectomy group compared with the nonoperative controls. Results: A total of 233,496 participants were included (mean age, 54.7 ± 12.7 years; 52.6% men). During the mean follow-up period of 4.8 ± 1.7 years, 6450 patients (5.5%) were newly diagnosed with CKD in the cholecystectomy group. Cholecystectomy was an independent risk factor for the development of CKD after adjustment for confounders, including age, sex, income, health behaviors, and comorbidities. The risk of CKD was 21% higher in the cholecystectomy group compared to the non-cholecystectomy group (aHR, 1.21; 95% CI, 1.17-1.26). The increased risk of CKD in the cholecystectomy group was consistently significant when a stratified analysis by age, sex, and presence or absence of comorbidities was conducted. Conclusions: Cholecystectomy was independently associated with an increased risk of developing CKD in a nationwide population-based study. Therefore, careful and long-term monitoring of the risk of CKD after cholecystectomy is necessary.

Associations between body weight change and incidence of major depressive disorder in patients with type 2 diabetes mellitus: a nationwide longitudinal follow-up cohort study of 1.1 million

BACKGROUND

Comorbid depression substantially affects the management of glycemia and diabetes-related complications among patients with type 2 diabetes mellitus. In this study, we sought to determine the association between weight change over 4 years and depression risk among patients with type 2 diabetes mellitus.

METHODS

This population-based retrospective cohort study from the National Health Insurance Services of Korea included 1 111 345 patients with type 2 diabetes who were divided into groups according to body weight change over 4 years. Body weight changes were compared with the preceding 4-year period (2005-2008). Depression was defined according to the International Classification of Diseases 10th revision code for depression (F32 and F33) on one or more inpatient or outpatient claims.

RESULTS

During a median follow-up of 7.4 years, 244 081 cases of depression were identified. We observed a U-shaped association between body weight change and depression risk with a higher risk among both groups of weight loss (hazard ratio (HR) 1.17, 95% CI 1.15-1.19 for ⩾ -10%; HR 1.07, 95% CI 1.06-1.08 for -10 to -5%) and weight gain (HR 1.06, 95% CI 1.04-1.08 for ⩾10%; HR 1.02, 95% CI 1.01-1.04 for 5-10%) compared with the stable weight group (-5 to 5%).

CONCLUSIONS

A U-shaped association between body weight change and depression risk was observed in this large nationwide cohort study. Our study suggests that patients with type 2 diabetes and weight change, either gain or loss, could be considered a high-risk group for depression.

Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study

BACKGRUOUND

We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM).

METHODS

For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317).

RESULTS

During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status.

CONCLUSION

Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.

Prevalence and Factors Associated With Post-Cholecystectomy Syndrome in Saudi Arabia

OBJECTIVES

Post-cholecystectomy syndrome (PCS) refers to the continuation or recurrence of biliary colic and any other gastrointestinal symptoms present prior to cholecystectomy. Given that PCS is rare and underestimated in Saudi Arabia, this study aimed to determine the prevalence of PCS among Saudis.

METHODS

This cross-sectional study included randomly gathered subjects who self-administered the validated European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire from September 6 to October 7, 2022.

RESULTS

A total of 518 participants who underwent cholecystectomies were included; most were female (73.6%), 153 (29.5%) were 19 to 25 years old, and the vast majority were Saudi Arabian (91.1%). The average preoperative weight was 71 ± 20.7 kg (range 20 to 258), and the mean current weight was 69 ± 19.4 kg (range 30 to 257). About 137 (26.4%) had a chronic disease, most frequently hypertension (37.2%). In the past week, most participants experienced some trouble doing strenuous activities (42.9%), slight pain (37.6%), fatigue (32.2%), insomnia (37.5%), and weakness (38.2%). There were no significant associations between age, nationality, or residence with the QLQ-C30 score (P-value = 0.152, 0.262, 0.071, respectively). A significant association was observed between gender and QLQ-C30 score (P-value < 0.001), with females scoring higher than their male counterparts. Females also reported having a higher quality of life than males.

CONCLUSIONS

The prevalence of PCS was higher than reported elsewhere.

Update on the natural orifice transluminal endoscopic surgery for gallbladder preserving gallstones therapy: A review

Cholecystectomy remains the "gold standard" for the management of symptomatic gallstones. Minimally invasive laparoscopic cholecystectomy has been the treatment of choice for the past 3 decades. However, the technique of natural orifice transluminal endoscopic surgery cholecystolithotomy is evolving, with some experts advocating gallbladder stone removal without gallbladder excision in order to preserve gallbladder function and eliminate post-cholecystectomy syndromes, including complications of the surgical incision, bile duct injury, functional gastrointestinal, and psychological conditions, and possibly an increase in colon cancer. In addition, transluminal endoscopic cholecystolithotomy is an option for elderly patients who are not suitable candidates for open surgery and those who desire scar-free minimally invasive surgery with organ preservation. This article summarizes the established pure natural orifice transluminal endoscopic surgery gallbladder preserving gallstone removal techniques and highlights the pros and cons of different popular available endoscopic approaches to gallstone therapy and how flexible endoscopic surgery via the natural orifice is compared to the well-established cholecystectomy.