Burden of gallstone disease in the United States population: Prepandemic rates and trends

General surgeon workforce density is not associated with treatment-incidence ratios at the county or hospital service area level in North Carolina

BACKGROUND

General Surgeon Workforce Density (WFD) is used to approximate surgical access. Treatment-incidence ratios (TIR) provide a novel measure of care access. TIR's association with General Surgeon WFD has not been evaluated.

STUDY DESIGN

Retrospective cohort study of North Carolina inpatient discharges (2016-2019). The association between county and Hospital Service Area (HSA) TIRs for general surgical diseases was analyzed using adjusted linear and logistic regression.

RESULTS

When adjusting for pertinent covariates, county General Surgeon WFD and TIR (-0.0009, 95 ​% CI -0.028,0.026; p 0.95) and HSA General Surgeon WFD and TIR (0.008, 95 ​% CI -0.021,0.037; p ​0.58) were not statistically significantly associated. The odds of a county 0.91 (95 ​% CI 0.42,1.97; p 0.82) or HSA (OR 0.93, 95 ​% CI 0.43,2.04; p 0.86) having a high TIR was not associated with WFD.

CONCLUSION

General Surgeon WFD is not associated with disease-specific procedural rates of common surgical conditions at the county or HSA level.

Impact of the robotic platform and surgeon variation on cholecystectomy disposable costs-More is not better

BACKGROUND

We hypothesized that surgeon variation in equipment and platform during cholecystectomy would increase costs without measurable benefit.

METHODS

We retrospectively reviewed all cholecystectomies from a large health care system. Using a mixed model, we modeled disposable instrument costs and outcomes. Independent variables included patient, hospital, surgeon factors and the surgical platform.

RESULTS

From 2017 to 2024, we analyzed 13,548 laparoscopic cholecystectomies and 1,258 robotic cholecystectomies performed by 98 surgeons across 14 hospitals. The proportion of robotic cholecystectomy usage increased from 0.1% in 2017 to 26% (522 of 2021) in 2024. The unadjusted disposable cost (mean, median, and the 25th percentile) was $669 ± $4.2, $534, and $448 for laparoscopic cholecystectomy and $1,447 ± $18, $1,309, and $1,120 for robotic cholecystectomy, respectively. The cheapest surgeon's mean cost was $272 ± $37 (n = 16), and the most expensive was $1,934 ± $108 (n = 223), both laparoscopic only. For robotic cholecystectomies, the least costly surgeon averaged $1,062 ± $23 (n = 52). Using our mixed models, robotic cholecystectomy was on average $817 ± $22 more expensive than laparoscopic cholecystectomy (P < .001); there was no meaningful difference in mean operating room times, readmission rates, length of stay, or 30-day reintervention rate between surgical platforms. However, robotic cholecystectomies predicted a substantially lower conversion rate (odds ratio: 0.20 ± 0.11, P = .004) or $93,000 per conversion prevented. If all surgeons operated at the 25th percentile of a platform's mean cost, a potential disposal equipment savings of 35% for laparoscopic cholecystectomy and 24% for robotic cholecystectomy could be realized.

CONCLUSION

Robotic cholecystectomy costs were 2.5 times greater than those for laparoscopic cholecystectomy. In addition, surgeons' disposable equipment choices also substantially impact cholecystectomy costs. Neither platform nor excess costs provide any substantial measurable outcome benefit.

Resveratrol prevents gallstones in mice fed on a high fat diet via regulating PPAR-γ and SR-BI

Background

With the gradual improvement of living standards, the incidence of gallstones is getting higher and higher, and cholesterol gallstones (CG) are the most prevalent subtype. Therefore, we urgently need a better way to treat gallstones.

Objective

This study aimed to evaluate the effects of resveratrol (Res) on cholesterol gallstone formation and explore its underlying mechanisms, focusing on its modulation of hepatic peroxisome proliferator-activated receptor γ (PPAR-γ) expression, bile cholesterol saturation, and hepatic cholesterol metabolism.

Methods

Thirty-two male C57BL/6 mice were randomly divided into four groups: control, model, ursodeoxycholic acid (UDCA), and Res groups. Res (100 mg/kg/day) and UDCA (100 mg/kg/day) were administered via gavage for 5 weeks. Gallbladder bile, liver, and gallbladder tissues were collected for bile cholesterol crystal analysis, bile lipid profiling, and histopathological examination. Protein expression levels of PPARγ and scavenger receptor class B type I (SR-BI) were analyzed using Western blotting and immunohistochemistry.

Results

Mice fed on a high fat diet resulted in larger gallbladder (about 2 times in both long and width diameters compared to control group) and CG formation, while resveratrol treatment significantly reduced gallstone formation, improved gallbladder dilatation, and declined cholestasis symptoms. Res suppressed hepatic inflammation by downregulating the receptor for advanced glycation end products (RAGE) expression and inhibiting the synthesis of proinflammatory factors. Res alleviated liver lipid deposition. It also enhanced PPARγ and SR-BI expression, promoting cholesterol efflux and lowering cholesterol levels, thereby preventing CG formation in mice.

Conclusion

Resveratrol demonstrates significant potential as a therapeutic agent for the prevention and treatment of cholesterol gallstone disease (CGD) by modulating hepatic cholesterol metabolism, reducing bile cholesterol saturation, and alleviating hepatic inflammation. Further studies are warranted to explore its clinical applicability in humans.

Clinical and patient-reported outcomes following subtotal cholecystectomy: 10-year single-institution experience

OBJECTIVE

Subtotal cholecystectomy provides a safe, bail-out alternative for difficult gallbladders. However, long-term outcomes comparing fenestrating and reconstituting subtotal cholecystectomy subtypes remain underexplored.

METHODS

This retrospective cohort included patients who underwent subtotal cholecystectomy between 2010 and 2020 within a single hospital system. Subtotal cholecystectomy was identified by parsing operative notes for keywords. Demographic and clinical variables were collected by manual review. Patient-reported outcomes were collected via phone using an abbreviated Gastrointestinal Quality-of-Life Index.

RESULTS

We identified 218 subtotal cholecystectomies, with 113 (51.8%) fenestrating subtotal cholecystectomy and 105 (48.2%) reconstituting subtotal cholecystectomy and a median follow-up of 63 months (interquartile range 27-106). Rates of bile duct injury (0.9% vs 1.0%; P > .99), bile leak (10.6% vs 9.5%; P > .99), and 30-day readmission (7.6% vs 8.0%; P > .99) did not differ between fenestrating and reconstituting subtotal cholecystectomy. For fenestrating subtotal cholecystectomy, the postoperative bile leak rate decreased fourfold when cystic duct closure was achieved (6.0% vs 24.1%; P = .012). Subtotal cholecystectomies completed laparoscopically had fewer postoperative bile leaks (2.9% vs 16.8%; P = .001), fewer wound complications (4.8% vs 13.3%; P = .035), and decreased length of stay (7.00 ± 9.07 vs 10.15 ± 13.50 days; P < .001) compared with open operations. The survey response rate was 38.9% (n = 51/131); 47 patients (92.2%) did not report recurrent biliary pain or postprandial nausea or vomiting, but 19 patients (37.2%) reported dietary restriction. Long-term completion cholecystectomy rate was 0.9%.

CONCLUSION

Given no notable difference in postoperative or quality of life outcomes between subtotal cholecystectomy subtypes, consideration of technique depends on intraoperative conditions. Cystic duct closure during fenestrating subtotal cholecystectomy and laparoscopic completion of subtotal cholecystectomy are associated with improved postoperative outcomes.

Inflammatory burden index (IBI) and body roundness index (BRI) in gallstone risk prediction: insights from NHANES 2017-2020

BACKGROUND

The Inflammatory Load Index (IBI) and Body Roundness Index (BRI) were employed to evaluate the systemic inflammatory status and body fat. This study aims to elucidate the association between IBI and the prevalence of gallstones, as well as to analyze the mediating role of BRI in this association.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) (2017-2020) were utilized in our cross-sectional study. A total of 2598 participants aged ≥ 20 years were enrolled. The Boruta algorithm, a supervised classification feature selection method, is leveraged to identify the confounding variables most strongly associated with the prevalence of gallstones. Weighted multivariate logistic regression, restricted cubic splines (RCS), and subgroup analyses were employed to investigate the association between IBI and gallstones, assess the presence of a linear association, and evaluate the effect of IBI on gallstone risk across different populations. Finally, the mediating effect of BRI was examined.

RESULTS

In the fully adjusted model, when IBI was in the highest tertile, each unit increase in IBI (corresponding to an increase of 1 in the natural logarithm of IBI) was linked to a 110.8% higher prevalence of gallstones (OR = 2.108, 95% CI: 1.109-4.005; P = 0.028). The odds ratio for gallstones increased with higher IBI levels across unadjusted, partially adjusted, and fully adjusted models (P for trend < 0.05). This positive association was confirmed to be linear by the RCS curve (P for nonlinear = 0.887). Subgroup analysis indicated that the risk of gallstones was significantly elevated in individuals aged ≥ 60, females, and those with a Poverty-to-Income Ratio (PIR) ≥ 2 (P < 0.05). Mediation analysis revealed that IBI had a significant indirect effect on gallstone prevalence through BRI, with an effect size of 0.0129 (95% CI: 0.0121-0.0136; P < 0.001), and the mediation contributed to 33.24% of the total effect.

CONCLUSIONS

This study demonstrates a significant linear positive relation of IBI to gallstone prevalence. Furthermore, BRI mediates the effect of IBI on gallstone risk. These findings provide a more precise inflammatory marker for gallstone prevention and treatment.

TRIAL REGISTRATION

Not applicable.

Selective vs Routine Cholangiography Across a Health Care Enterprise

Importance

There is sparse literature on whether routine cholangiography (RC) vs selective cholangiography (SC) during cholecystectomy is associated with improved perioperative outcomes, regardless of whether an intraoperative cholangiogram (IOC) is performed.

Objective

To compare perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform IOC.

Design, Setting, and Participants

This retrospective cohort study was conducted from January 2015 through June 2023 and took place within the Cleveland Clinic Enterprise, which includes 18 hospitals and 9 ambulatory surgery centers in 2 states (Ohio and Florida). Participants included adult patients who underwent cholecystectomy for benign biliary disease. Data analysis was conducted between July 2023 and August 2024.

Exposure

Routine cholangiography, defined as more than 70% of cholecystectomies performed with IOC per surgeon over the study period.

Main Outcome(s) and Measure(s)

The primary outcome was major bile duct injury (BDI). Hierarchical mixed-effects models with patients nested in hospitals adjusted for individual- and surgeon-level characteristics were used to assess the odds of major BDI and secondary outcomes (minor BDI, operative duration, and perioperative endoscopic retrograde cholangiopancreatography [ERCP]).

Results

A total of 134 surgeons performed 28 212 cholecystectomies with 10 244 in the RC cohort (mean age, 52.71 [SD, 17.78] years; 7102 female participants [69.33%]) and 17 968 in the SC cohort (mean age, 52.33 [SD, 17.72] years; 12 135 female participants [67.54%]). Overall, 26 major BDIs (0.09%) and 105 minor BDIs (0.34%) were identified. Controlling for patient and surgeon characteristics nested in hospitals, RC was associated with decreased odds of major BDI (odds ratio [OR], 0.16; 95% CI, 0.15-0.18) and minor BDI (OR, 0.83; 95% CI, 0.77-0.89) compared with SC. Major BDIs were recognized intraoperatively more often in the RC cohort than the SC cohort (76.9% vs 23.0%; difference, 53.8%; 95% CI, 15.9%-80.2%). Lastly, RC was not significantly associated with increased perioperative ERCP utilization (OR, 1.01; 95% CI, 0.90-1.14) or negative ERCP rate (RC, 27 of 844 [3.2%] vs SC, 57 of 1570 [3.6%]; difference, -0.3%; 95% CI, -1.9% to 1.0%).

Conclusions and Relevance

In this study, RC was associated with decreased odds of major and minor BDI, as well as increased intraoperative recognition of major BDI when it occurred. RC could be considered as a health systems strategy to minimize BDI, acknowledging the overall low prevalence but high morbidity from these injuries.

Endoscopic Management of Benign Pancreaticobiliary Disorders

Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates. EUS-GBD leverages lumen-apposing metal stents (LAMS) for direct access to the gallbladder, providing the ability to treat an inflamed GB internally. Choledocholithiasis is primarily managed with ERCP, utilizing techniques to include balloon extraction, mechanical lithotripsy, or advanced methods such as electrohydraulic or laser lithotripsy in cases of complex stones. Altered anatomy from bariatric procedures like Roux-en-Y gastric bypass may necessitate specialized approaches, including balloon-assisted ERCP or EUS-directed transgastric ERCP (EDGE). Post-operative complications, including bile leaks and strictures, are managed endoscopically using sphincterotomy and stenting. Post-liver transplant anastomotic and non-anastomotic strictures often require repeated stent placements or advanced techniques like magnetic compression anastomosis in refractory cases. In chronic pancreatitis (CP), endoscopic approaches aim to relieve pain and address structural complications like pancreatic duct (PD) strictures and calculi. ERCP with sphincterotomy and stenting, along with extracorporeal shock wave lithotripsy (ESWL), achieves effective ductal clearance for PD stones. When traditional approaches are insufficient, direct visualization with peroral pancreatoscopy-assisted lithotripsy is utilized. EUS-guided interventions, such as cystgastrostomy, pancreaticogastrostomy, and celiac plexus blockade, offer alternative therapeutic options for pain management and drainage of peripancreatic fluid collections. EUS plays a diagnostic and therapeutic role in CP, with procedures tailored for high-risk patients or those with complex anatomy. As techniques evolve, endoscopic management provides minimally invasive alternatives for patients with complex benign pancreaticobiliary conditions, offering high clinical success and fewer complications.

Biliary Dyskinesia - Is It Real?

Introduction

Biliary dyskinesia is a functional gallbladder disorder characterized by altered gallbladder motility. This often presents as history of biliary symptoms without imaging evidence of gallstones, sludge, or other structural pathology. The diagnosis is made by demonstration of abnormal gallbladder emptying on hepatic iminodiacetic acid analogue scan with cholecystokinin administration (HIDA-CCK). The aim of this study was to determine if patients with biliary dyskinesia who undergo cholecystectomy have abnormal pathology and resolution of symptoms.

Methods

This is a retrospective cohort study reviewing patients with symptomatic cholelithiasis or biliary dyskinesia who underwent cholecystectomy by a single surgical practice from 2015 to 2019. Clinical symptoms, radiologic findings and surgical pathology were assessed. The primary endpoints were pathologic changes and symptom resolution after cholecystectomy. Secondary endpoints were correlation of symptomatic disease with gender, age, and body mass index (BMI). Variables are presented as median (interquartile range [IQR] or frequency [%]).

Results

Four hundred and fifteen patients met inclusion criteria. Of these patients, 89 patients (21%) had biliary dyskinesia. The age of patients with biliary dyskinesia was 46 (33-58) years with the BMI of patients with biliary dyskinesia being 28 (24-33). A total of 82 patients with biliary dyskinesia were women (92%). Patients diagnosed with calculus disease (symptomatic cholelithiasis, acute calculous cholecystitis, choledocholithiasis) had an age of 55 (35-69) years. The majority (214 [66%]) of patients were women with calculus disease and 153 (71%) women had symptomatic cholelithiasis. Significance was observed in BMI between the groups, with the overall being 29 (25-35). The most common presenting symptom was abdominal pain, reported by 86 (97%) patients with biliary dyskinesia. The median ejection fraction (EF) was 18% (11-27%). Three patients with biliary dyskinesia (3%) had a median EF of 94% (86-99%), consistent with hyperkinetic biliary dyskinesia (>80%). Pathology demonstrated chronic cholecystitis in 75 specimens (84%), normal in 9 specimens (10%), and cholesterolosis alone in 5 specimens (7%). All patients experienced resolution of symptoms postoperatively.

Conclusion

Symptomatic patients with evidence of biliary dyskinesia were more likely to be younger and have a lower BMI than those with cholelithiasis and occurred most commonly for women. Most patients with biliary dyskinesia had histologic evidence of chronic gallbladder inflammation. Cholecystectomy resulted in resolution of symptoms in all patients with biliary dyskinesia. Cholecystectomy should be considered for first-line treatment of patients presenting with biliary symptoms, negative ultrasound findings and scintigraphic evidence of abnormal biliary function.

Burden of Digestive Diseases in the United States Population: Rates and Trends

Digestive diseases are common in the United States and lead to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to expand on earlier findings and investigate rates and trends in the digestive disease burden in the United States. The Nationwide Emergency Department Sample, National Inpatient Sample, Vital Statistics of the United States: Multiple Cause-of-Death Data, Optum Clinformatics Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care, and mortality with a digestive disease diagnosis. Digestive disease prevalence (claims-based, 2019) was 24.2% among Medicaid beneficiaries, 33.2% among private insurance enrollees, and 51.5% among Medicare beneficiaries and rose over the previous decade. Digestive diseases contributed to 42 million emergency department visits, 17 million hospital stays, and 472,000 deaths in 2019. Women had higher medical care rates with a digestive disease diagnosis, but mortality rates were higher among men. Blacks had higher medical care use and mortality rates compared with Whites, and Hispanics had lower rates. During the study period, ambulatory care and emergency department visit rates with a digestive disease diagnosis rose, while hospitalization and mortality rates declined. Among private insurance enrollees, rates were higher compared with national data for hospitalizations, but lower for emergency department visits. The digestive disease burden in the United States is substantial, particularly among Blacks and older adults. Further research is needed to better understand reasons for disparities and trends in health care use and mortality reported in this paper.

Biliary complications of surgical procedures: what the radiologist needs to know

Post-surgical biliary complications increase morbidity, mortality, and healthcare utilization. Early detection and management of biliary complications is thus of great clinical importance. Even though the overall risk for biliary complications is low after laparoscopic cholecystectomy, post-cholecystectomy biliary complications are frequently encountered in clinical practice as laparoscopic cholecystectomy is the most common surgical procedure performed in the United States. Other surgical procedures fraught with biliary complications include liver transplantation, pancreaticoduodenectomy, hepatic resection, and gastric surgeries.The clinical presentation of biliary complications is variable; imaging, thus, plays a vital role in diagnosis and management. Biliary leak (BL) and stricture are the most common biliary complications. Although Ultrasound (US) and Computed Tomography (CT) can detect collections and free fluid due to a BL, imaging confirmation of a biliary origin requires the use of a Hepatobiliary Iminodiacetic Acid (HIDA) scan or Magnetic Resonance Cholangiopancreatography (MRCP) with hepatocyte-specific contrast agent. Biliary strictures can present months to years after the original injury; the attendant biliary dilation is well seen on cross-sectional modalities. MRCP plays a crucial role in excluding features suggestive of a malignant etiology and establishing the type and anatomical extent of the injury for therapeutic planning. Radiologists thus play a vital role in detecting and managing biliary complications. This article provides an overview of the applied anatomy, clinical presentation, imaging, and therapeutic considerations of biliary complications after surgical procedures.

Biliary Endoscopic Retrograde Cholangiopancreatography

Since inception in 1968, biliary endoscopic retrograde cholangiopancreatography (ERCP) has transformed into a highly effective, minimally invasive modality for the identification and treatment of a variety of biliary pathologies including benign, malignant, and iatrogenic diseases. The diagnostic role of ERCP has been largely replaced by high-quality imaging modalities including endoscopic ultrasound and magnetic resonance cholangiopancreatography. However, there continues to be significant demand for therapeutic procedures. This article reviews the general principles of ERCP, as well as common indications, contraindications, and potential adverse events with which endoscopists and referring physicians should be familiar.

Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies

BACKGROUND

Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy.

METHODS

In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model.

RESULTS

Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates.

CONCLUSION

This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.

The relationship between high-sensitivity C-reactive protein and gallstones: a cross-sectional analysis

Background and objective

High-sensitivity C-reactive protein (hs-CRP), a classical indicator of inflammation, holds significant clinical value in various diseases. The relationship between hs-CRP and gallstones, however, remains poorly studied at present. The relationship between hs-CRP and gallstones will be investigated in this study.

Methods

Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, focusing on participants aged 20 years and older who provided complete hs-CRP and gallstone information. Due to the skewed distribution of hs-CRP, the data were log-transformed [Log (hs-CRP)] to achieve normalization. Logistic regression analysis, subgroup analysis, and smoothed fitted curves were applied to determine the relationship between Log (hs-CRP) and the presence of gallstones.

Results

The study included 4,484 participants with an average Log (hs-CRP) of 1.18 ± 0.74. The prevalence of gallstones was 11.15%, increasing with higher Log (hs-CRP) levels (quartile 1: 8.31%; quartile 2: 8.76%; quartile 3: 11.98%; quartile 4: 16.36%; p < 0.0001). Adjusting for all covariates in Model 3, each 10-fold increase in hs-CRP [corresponding to a one-unit increase in log10 (hs-CRP)] corresponded to a 29% increased odds of gallstones prevalence [1.29 (1.12-1.49)]. The smoothed fitted curve showed a positive linear relationship between Log (hs-CRP) and gallstones prevalence. The results of subgroup analyses exhibited a more pronounced positive correlation in the 20-40 age group [1.70 (1.33, 2.16)], compared to those aged 40-60 years [1.22 (1.01, 1.48)], and 60-80 years [1.14 (0.98, 1.34)].

Conclusion

Higher Log (hs-CRP) levels are linked to a greater prevalence of gallstones. We still need to carry out further large prospective research to explore the causal relationship of this association.

Association between life-ever gallstones and depressive symptoms in U.S. adults: a cross-sectional study

Research on the potential association between life-ever gallstones and depressive symptoms is limited. This study aims to evaluate whether the presence of gallstone disease is associated with depressive symptoms. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 cycles. The presence of depressive symptoms and gallstone disease was assessed using questionnaire responses. Adjusted odds ratios (OR) were calculated using a multivariate logistic regression model, with adjustments made for age, sex, race, body mass index, history of cardiovascular disease, hypertension, arthritis, and pulmonary disease across different models. Subgroup and sensitivity analyses were conducted to ensure the stability of the results. This study included 6201 adults aged 20 years and above, with 539(8.7%) experiencing depressive symptoms. After adjusting for age, sex, race, body mass index, CVD history, hypertension, arthritis, pulmonary disease, depressive symptoms were possibly associated with life-ever gallstones (OR 1.37, 95% CI 0.91-2.08).When depressive symptoms were categorized as mild, moderate, moderately severe, and severe,life-ever gallstones was possibly associated with mild depressive symptoms (OR 1.12, 95% CI 0.81-1.56), moderate depressive symptoms (OR 1.37, 95% CI 0.89-2.12), moderately severe depressive symptoms (OR 1.93, 95% CI 0.93-3.99), and severe depressive symptoms (OR 0.67, 95% CI 0.16-2.88).As a continuous variable, life-ever gallstones was associated with the PHQ-9 score (OR 0.42, 95% CI 0.02-0.83). The results remained stable after multiple imputation for all missing data. This cross-sectional study demonstrates no significant association between life-ever gallstones and depressive symptoms in US adults.