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Costa CJ, Nguyen MTT, Vaziri H, Wu GY. Genetics of Gallstone Disease and Their Clinical Significance: A Narrative Review. J Clin Transl Hepatol 2024; 12:316-326. [PMID: 38426197 PMCID: PMC10899874 DOI: 10.14218/jcth.2023.00563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Gallstone (GS) disease is common and arises from a combination of genetic and environmental factors. Although genetic abnormalities specifically leading to cholesterol GSs are rare, there are clinically significant gene variants associated with cholesterol GSs. In contrast, most bilirubin GSs can be attributed to genetic defects. The pathogenesis of cholesterol and bilirubin GSs differs greatly. Cholesterol GSs are notably influenced by genetic variants within the ABC protein superfamily, including ABCG8, ABCG5, ABCB4, and ABCB11, as well as genes from the apolipoprotein family such as ApoB100 and ApoE (especially the E3/E3 and E3/E4 variants), and members of the MUC family. Conversely, bilirubin GSs are associated with genetic variants in highly expressed hepatic genes, notably UGT1A1, ABCC2 (MRP2), ABCC3 (MRP3), CFTR, and MUC, alongside genetic defects linked to hemolytic anemias and conditions impacting erythropoiesis. While genetic cases constitute a small portion of GS disease, recognizing genetic predisposition is essential for proper diagnosis, treatment, and genetic counseling.
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Affiliation(s)
- Christopher J. Costa
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Minh Thu T. Nguyen
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Haleh Vaziri
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Ozturk D, Sivaslioglu A, Bulus H, Ozturk B. TyG index is positively associated with HOMA-IR in cholelithiasis patients with insulin resistance: Based on a retrospective observational study. Asian J Surg 2024:S1015-9584(24)00431-7. [PMID: 38508891 DOI: 10.1016/j.asjsur.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/24/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND/OBJECTIVE Cholelithiasis is a common disease but pose significant global health and financial burdens. Mechanisms of the disease are associated with insulin resistance (IR), obesity, metabolic syndrome, and type 2 diabetes. Insulin resistance is commonly observed in cholelithiasis patients. More recently, the triglyceride-glucose (TyG) index has been proposed as an alternative marker of insulin resistance. In our study we aimed to understand whether the TyG index is correlated with HOMA-IR in cholelithiasis patients. And also we aimed the predict a cutoff value for determining insulin resistance in cholelithiasis patients. METHODS A total of 184 cholelithiasis patients were matched in terms of age, gender, and BMI. They were divided into two groups based on their Homa IR levels (IR and Non-IR group). This study was a retrospective, observational study and clinical data was obtained from electronic medical records. Cutoff value for Tyg index was established through ROC Analysis. Binary Logistic Regression was used to identify factors affecting insulin resistance. RESULTS A significant cutoff value was found for the TyG index in determining the presence of insulin resistance. Having a TyG index of ≥8.71 indicates the presence of insulin resistance. The sensitivity was 68.48%, the specificity was 58.70%. Binary Logistic Regression analyses showed that an increase in Tyg Index, waist circumference and waist-to-height ratio values increases the risk of insulin resistance by 2.705 (p = 0.001), 1.032 (p = 0.029), and 334.057 (p = 0.012) times respectively. CONCLUSION Our study indicated that TyG index is positively correlated with HOMA-IR. TyG index was found as a risk factor for insulin resistance.
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Affiliation(s)
- Dogan Ozturk
- University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Department of General Surgery, Ankara, Turkiye
| | - Aysegul Sivaslioglu
- Hacettepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkiye.
| | - Hakan Bulus
- University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Department of General Surgery, Ankara, Turkiye
| | - Bulent Ozturk
- University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Department of General Surgery, Ankara, Turkiye
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Feng Y, Liang Y, Liu Y, Zhang Y, Huang S, Ren L, Ma X, Zhou A, Shi R. Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety. Surg Endosc 2024; 38:1637-1646. [PMID: 38286835 DOI: 10.1007/s00464-024-10684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure. METHODS Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence. CONCLUSIONS The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.
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Affiliation(s)
- Yadong Feng
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Yan Liang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yang Liu
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yinqiu Zhang
- Department of Gastroenterology, Previously School of Medicine, Humanity Hospital, Southeast University, 3777 Yuexian Road, Xiamen, 361006, China
| | - Shuaijing Huang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Lihua Ren
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Xiaojun Ma
- Department of Translational Research, Nanjing Microtech Medical Technology Co. Ltd., 10 Gaoke 3rd Road, Nanjing, 210018, China
| | - Aijun Zhou
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Ruihua Shi
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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Duhancioglu G, Arif-Tiwari H, Natali S, Reynolds C, Lalwani N, Fulcher A. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol (NY) 2024; 49:722-737. [PMID: 38044336 DOI: 10.1007/s00261-023-04107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
Abstract
Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.
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Affiliation(s)
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
| | - Stefano Natali
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Conner Reynolds
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Neeraj Lalwani
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
| | - Ann Fulcher
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
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Moriyama T, Ohuchida K, Ohtsuka T, Shindo K, Ikenaga N, Nakata K, Nakamura M. Higher incidence of cholelithiasis with Roux-en-Y reconstruction compared with Billroth-I after laparoscopic distal gastrectomy for gastric cancer: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:75. [PMID: 38409456 DOI: 10.1007/s00423-024-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Cholelithiasis occurs often after gastrectomy. However, no consensus has been established regarding the difference in the incidence of postgastrectomy cholelithiasis with different reconstruction methods. In this study, we examined the frequency of cholelithiasis after two major reconstruction methods, namely Billroth-I (B-I) and Roux-en-Y (R-Y) following laparoscopic distal gastrectomy (LDG) for gastric cancer. METHODS Among 696 gastric cancer patients who underwent LDG between April 2000 and March 2017, after applying the exclusion criteria, 284 patients who underwent B-I and 310 who underwent R-Y were examined retrospectively. The estimated incidence of cholelithiasis was compared between the methods, and factors associated with the development of cholelithiasis in the gallbladder and/or common bile duct were investigated. RESULTS During the median follow-up of 61.2 months, 52 patients (8.8%) developed cholelithiasis postgastrectomy; 12 patients (4.2%) after B-I and 40 (12.9%) after R-Y (p = 0.0002). Among them, choledocholithiasis was more frequent in patients who underwent R-Y (n = 11, 27.5%) vs. B-I (n = 1, 8.3%) (p = 0.0056). Univariate and multivariate analyses revealed that male sex, body mass index > 22.5 kg/m2, and R-Y reconstruction were significant predictors of the development of postLDG cholelithiasis. CONCLUSION Regarding cholelithiasis development, B-I reconstruction should be preferred whenever possible during distal gastrectomy.
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Affiliation(s)
- Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
- Seiryo Iwasato Hospital, Hita, Oita, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan.
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
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Kermansaravi M, Shikora S, Dillemans B, Kurian M, LaMasters T, Vilallonga R, Prager G, Chiappetta S. The Management of Biliary Disease in Patients with Severe Obesity Undergoing Metabolic and Bariatric Surgery-An International Expert Survey. Obes Surg 2024:10.1007/s11695-024-07101-y. [PMID: 38400945 DOI: 10.1007/s11695-024-07101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate the management of biliary disease in patients with severe obesity undergoing MBS. BACKGROUND Obesity and rapid weight loss after MBS are risk factors for the development of gallstones. Complications, such as cholecystitis, acute cholangitis, and biliary pancreatitis, are potentially life-threatening, and no guidelines for the proper management of gallstone disease exist. METHODS An international scientific team designed an online confidential questionnaire with 26 multiple-choice questions. The survey was answered by 86 invited experts (from 38 different countries), who participated from August 1, 2023, to September 9, 2023. RESULTS Two-thirds of experts (67.4%) perform concomitant cholecystectomy in symptomatic gallstones during MBS. Half of experts (50%) would wait 6-12 weeks between both surgeries with an interval approach. Approximately 57% of the experts prescribe ursodeoxycholic acid (UDCA) prophylactically after MBS, and most recommend a 6-month course. More than the half of the experts (59.3%/53.5%) preferred laparoscopic assisted transgastric ERCP as the approach for treating CBD stones in patients who previously had RYGB/OAGB. CONCLUSION Concomitant cholecystectomy is preferred by the experts, although evidence in the literature reports an increased complication rate. Prophylactic UDCA should be recommended to every MBS patient, even though the current survey demonstrated that not all experts are recommending it. The preferred approach for treating common bile duct stones is a laparoscopic assisted transgastric ERCP after gastric bypass. The conflicting responses will need more scientific work and clarity in the future.
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Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
| | - Marina Kurian
- Department of Surgery, NYU Langone Medical Center, New York, NY, 10016, USA
| | - Teresa LaMasters
- UnityPoint Clinic Weight Loss Specialists, West Des Moines, IA, USA
| | - Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Surgery Department, University Hospital Vall Hebron, Barcelona, Spain
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General and Laparoscopic Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
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Mi J, Jiang Q, Qi Z, Liu Z, Bai X, Zheng X, Wu J, Fang Y, Yang A, Chen H. Plasma campesterol and ABCG5/ABCG8 gene loci on the risk of cholelithiasis and cholecystitis: evidence from Mendelian randomization and colocalization analyses. Hum Genomics 2024; 18:19. [PMID: 38347599 PMCID: PMC10863091 DOI: 10.1186/s40246-024-00583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
The causal relationships between plasma metabolites and cholelithiasis/cholecystitis risks remain elusive. Using two-sample Mendelian randomization, we found that genetic proxied plasma campesterol level showed negative correlation with the risk of both cholelithiasis and cholecystitis. Furthermore, the increased risk of cholelithiasis is correlating with the increased level of plasma campesterol. Lastly, genetic colocalization study showed that the leading SNP, rs4299376, which residing at the ABCG5/ABCG8 gene loci, was shared by plasma campesterol level and cholelithiasis, indicating that the aberrant transportation of plant sterol/cholesterol from the blood stream to the bile duct/gut lumen might be the key in preventing cholesterol gallstone formation.
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Affiliation(s)
- Jiarui Mi
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Qingwei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhengwei Qi
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Zhengye Liu
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xia Zheng
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jiaguo Wu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Yanfei Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haotian Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
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Gong J, Feng Y, Mei Y, Han S, Sun X, Niu P, Tian J, Yan Q, Li H, Zhu W. Plasma metabolomics and proteomics reveal novel molecular insights and biomarker panel for cholelithiasis. J Pharm Biomed Anal 2024; 238:115806. [PMID: 37866078 DOI: 10.1016/j.jpba.2023.115806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Cholelithiasis is a gastrointestinal disease that is associated with the highest socioeconomic cost. A diagnosis of cholelithiasis based on clinical features is significantly limited, and direct molecular insights into cholelithiasis and the relationship between cholelithiasis and clinical biochemical parameters are unclear. OBJECTIVES Uncovering direct molecular insights into cholelithiasis and the relationship between cholelithiasis and clinical biochemical parameters. Identifying sensitive and specific biomarkers for this disease. METHODS Parallel metabolomic and proteomic analyses of plasma from cholelithiasis patients (CPs) and healthy control individuals (HCs) without cholelithiasis were performed using ultrahigh-performance liquid chromatography-tandem mass spectrometry. A multimodule coexpression network analysis and integrated machine learning methods, including least absolute shrinkage and selection operator, random forest, and support vector machine, were used for bioinformatic analyses. An independent cohort and the cross-validation of the combination of two cohorts were used to evaluate the diagnostic performance of the panel. RESULTS Arachidonic acid metabolism was significantly different between the CP and HC groups. Glyceraldehyde-3-phosphate dehydrogenase, actin beta, phosphoglycerate mutase 1, Enolase 1, Myeloperoxidase, and actin alpha 1 were identified as potential proteins related to cholelithiasis. The correlation between the merged modules and clinical biochemical tests was calculated. A diagnostic panel composed of four candidate biomarkers, including 3-oxotetradecanoic acid, 12-hydroxydodecanoic acid, hemoglobin subunit delta (HBD), and fibrinogen beta chain (FGB), was proposed based on three modules that were significantly associated with cholelithiasis. The classification according to the diagnostic panel detected CPs with an area under the curve (AUC) of 0.955. External validation in an independent cohort resulted in similar accuracy (AUC=0.995). CONCLUSIONS This study provided some direct molecular insights into cholelithiasis by showing the differences in plasma metabolic and protein profiles between CPs and HCs and presented a potential biomarker panel with two metabolites (3-oxotetradecanoic acid, 12-hydroxydodecanoic acid) and two proteins (HBD, FGB) for predicting cholelithiasis. We also explored the potential correlation of clinical biochemical parameters with combined modules. These findings may provide some reference for the diagnosis of cholelithiasis in clinical practice.
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Affiliation(s)
- Jiahui Gong
- Institute of Pharmacology, Zhejiang University of Technology, Hangzhou 310014, China; Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310002, China
| | - Yue Feng
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310002, China
| | - Ying Mei
- Department of Precision Medicine Clinical Research Center, Huzhou Central Hospital, Huzhou 313000, China; Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
| | - Shuwen Han
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China; Department of Medical Oncology, Huzhou Central Hospital, Huzhou 313000, China
| | - Xu Sun
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China; Department of Hepatobiliary and Pancreatic Surgery, Huzhou Central Hospital, Huzhou 313000, China
| | - Pingping Niu
- Department of Precision Medicine Clinical Research Center, Huzhou Central Hospital, Huzhou 313000, China; Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
| | - Jingkui Tian
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310002, China
| | - Qiang Yan
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China; Department of Hepatobiliary and Pancreatic Surgery, Huzhou Central Hospital, Huzhou 313000, China; Department of General Surgery, Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University, Huzhou 313000, China; Department of General Surgery, Huzhou Central Hospital, Affiliated Huzhou Central Hospital, The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou 313000, China; Huzhou Key Laboratory of Intelligent and Digital Precision Surgery, Huzhou 313000, China.
| | - Hanbing Li
- Institute of Pharmacology, Zhejiang University of Technology, Hangzhou 310014, China.
| | - Wei Zhu
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310002, China.
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Feleke AA, Birhanu FA, Tirfe FW, Molla YD. Agenesis of the right lobe of the liver: a case report. J Med Case Rep 2024; 18:19. [PMID: 38225604 PMCID: PMC10790392 DOI: 10.1186/s13256-023-04328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Agenesis of the right hepatic lobe is a rare congenital anomaly. Developmental anomalies of the right lobe of the liver were first reported in 1870 by Heller [6]. Anatomical variations of the liver are common, occur during the normal development of the organ, and correspond to variations in the distribution of liver territories. Agenesis of the right lobe of the liver is an incidental finding revealed by the popularization of ultrasonography, computed tomography, or magnetic resonance imaging due to the condition being asymptomatic. CASE PRESENTATION A 35-year-old Ethiopian female patient presented to the outpatient clinic with a complaint of right upper abdominal pain for 1 year, along with symptoms of fatty meal intolerance and long-standing epigastric burning pain. Her examination was unremarkable, and imaging investigations were suggestive of right hepatic lobe agenesis with multiple gallstones. Therefore, the patient was operated on and discharged with no perioperative complications. CONCLUSION Surgical understanding of such anatomical anomalies is necessary for surgical planning, the appropriate interpretation of intraoperative surgical findings, and the design of postoperative therapy. Here we report a case of right hepatic lobe agenesis with cholelithiasis and cholidocholithiasis and a brief review of right lobe agenesis in the literature.
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Affiliation(s)
- Ashenafi Amsalu Feleke
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Friehiwot Amsalu Birhanu
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fraol Worku Tirfe
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannis Derbew Molla
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Ostergar A, Alkazemi MH, Hill H, Awad MM, Ushinsky A, Darcy M, Desai AC, Figenshau RS. Successful Percutaneous Ultrasonic Lithotripsy of Gallstones. Ochsner J 2024; 24:84-86. [PMID: 38510219 PMCID: PMC10949052 DOI: 10.31486/toj.23.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. Case Series: We present the cases of 2 patients with acute calculous cholecystitis who were deemed ineligible candidates for cholecystectomy because of their complicating medical histories. Both patients initially underwent cholecystostomy and drain placement with interventional radiology for management of acute calculous cholecystitis. Their large gallstones remained refractory to attempts at removal by electrohydraulic lithotripsy via the cholecystostomy access. The patients' gallstones were successfully removed via percutaneous ultrasonic lithotripsy during a collaborative procedure with interventional radiology and urology. Conclusion: An interdisciplinary approach using percutaneous cholecystolithotomy with rigid ultrasonic lithotripsy is an effective method for removing challenging gallstones in patients for whom traditional approaches fail.
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Affiliation(s)
- Adam Ostergar
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Muhammad Hassan Alkazemi
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Hayden Hill
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael M. Awad
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alexander Ushinsky
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael Darcy
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alana C. Desai
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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11
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Cook LB, Gunasingha MRMKD, Dishman LS, Bartel LM, Bradley CM, Gosztyla LC. Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis. Am J Surg 2024; 227:96-99. [PMID: 37806893 DOI: 10.1016/j.amjsurg.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The project was performed to determine if referrals to non-surgical providers after an initial presentation of symptomatic cholelithiasis are associated with a delay in surgical management. METHODS A single institution chart review of all adult patients who underwent a cholecystectomy from 2015 to 2019 was completed. Quantitative data was analyzed using independent t-tests. RESULTS Of 574 reviewed, 482 patients met criteria. Following initial presentation, 295 (61.2%) received a referral to surgery and 187 (38.8%) received follow up with a non-surgical provider. Those in the latter group had a significantly longer time from initial symptom presentation to surgical evaluation (65.7 days vs. 10.3 days, p < 0.001) and cholecystectomy (102.0 days vs 39.1 days, p < 0.001) when compared to the surgery referral group. CONCLUSIONS This study demonstrated that cholecystectomy was significantly delayed for patients who had been referred to non-surgical providers after initial presentation, prolonging symptoms and increasing use of healthcare resources.
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Affiliation(s)
- Lt Brittany Cook
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.
| | - Maj Rathnayaka M K D Gunasingha
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Lt Sydney Dishman
- Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA; Naval Medical Center Portsmouth Department of Aviation Medicine, Carrier Air Wing Three, USA; En Route and Critical Care Research Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Lt Megan Bartel
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Cdr Matthew Bradley
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Lcdr Carolyn Gosztyla
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Ave, Bethesda, MD, 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA; En Route and Critical Care Research Department, Naval Medical Research Center, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
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12
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Liu W, Tu Z, Liu J, Wu T, Li D, Zhang N, Cui Y. Therapeutic effect of yinchenhao decoction on cholelithiasis via mucin in the gallbladder and intestine. Fitoterapia 2024; 172:105746. [PMID: 37967772 DOI: 10.1016/j.fitote.2023.105746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
Cholelithiasis is a common and frequently occurring disease worldwide that belongs to the category of jaundice in traditional Chinese medicine. Yinchenhao decoction (YD) consists of Artemisia capillaris Thunb., Gardenia jasminoides J.Ellis, and Rheum palmatum L., and is traditionally used to treat jaundice, which has a significant therapeutic effect on cholelithiasis. Our study aimed to investigate the pathological mechanism of cholelithiasis and the therapeutic mechanism of YD via mucin in the gallbladder and intestine. YD was prepared and analyzed using HPLC. The supersaturation stability experiment was designed by the solvent-shift method. The cell transport experiment was conducted by coculture monolayers. The animal experiment was performed using a cholelithiasis model with a high-cholesterol diet. The related indicators were detected by automatic biochemical analyzer, PCR, western blot, or ELISA. Statistics were analyzed using χ2-tests and t-tests. As the results, in cholelithiasis, MUC5AC highly expressed in the gallbladder shortened cholesterol supersaturation and promoted cholesterol crystallization via the inflammatory cytokine signaling pathway; MUC2 highly expressed in the small intestine prolonged cholesterol supersaturation and promoted cholesterol absorption via the inflammatory cytokine signaling pathway. YD inhibited mucin expression in the gallbladder and intestine in a concentration-dependent manner for cholelithiasis treatment by inhibiting the inflammatory cytokine signaling pathway, which was attributed to the active components, including chlorogenic acid, geniposide, and rhein.
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Affiliation(s)
- Weijun Liu
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China.
| | - Zhengwei Tu
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China
| | - Jinjin Liu
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China
| | - Teng Wu
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China
| | - Donghua Li
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China
| | - Nan Zhang
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China.
| | - Yunfeng Cui
- Tianjin NanKai Hospital, Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine for Acute Abdominal Diseases, No. 6 Changjiang Road, Nankai District, Tianjin 300100, China.
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Mortazavi H, Tizno A, Azadi A, Samani R, Firoozi N, Hazrati P. What is the impact of previous cholelithiasis on sialolithiasis: A systematic review and meta-analysis. Saudi Dent J 2024; 36:44-51. [PMID: 38375399 PMCID: PMC10874798 DOI: 10.1016/j.sdentj.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis. Methods PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software. Results Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04. Conclusion It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Tizno
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Azadi
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rojin Samani
- Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Firoozi
- Student Research Committee, School of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parham Hazrati
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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14
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Unalp-Arida A, Der JS, Ruhl CE. Longitudinal Study of Comorbidities and Clinical Outcomes in Persons with Gallstone Disease Using Electronic Health Records. J Gastrointest Surg 2023; 27:2843-2856. [PMID: 37914859 DOI: 10.1007/s11605-023-05861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Gallstone disease (GSD) is common and leads to significant morbidity, mortality, and health care utilization in the USA. We examined comorbidities and clinical outcomes among persons with GSD using electronic health records (EHR). METHODS In this retrospective study of 1,381,004 adults, GSD was defined by ICD-9 code 574 or ICD-10 code K80 using Optum® longitudinal EHR from January 2007 to March 2021. We obtained diagnosis, procedure, prescription, and vital sign records and evaluated associations between demographics, comorbidities, and medications with cholecystectomy, digestive cancers, and mortality. RESULTS Among persons with GSD, 30% had a cholecystectomy and were more likely to be women, White, and younger, and less likely to have comorbidities, except for obesity, gastroesophageal reflux disease (GERD), abdominal pain, hyperlipidemia, and pancreatitis. Among persons with GSD, 2.2% had a non-colorectal digestive cancer diagnosis during follow-up and risk was 40% lower among persons with a cholecystectomy. Non-colorectal digestive cancer predictors included older age, male sex, non-White race-ethnicity, lower BMI, other cancers, diabetes, chronic liver disease, pancreatitis, GERD, and abdominal pain. Among persons with GSD, mortality was 15.1% compared with 9.7% for the whole EHR sample. Persons with a cholecystectomy had 40% lower mortality risk and mortality predictors included older age, male sex, Black race, lower BMI, and most comorbidities. CONCLUSIONS In this EHR analysis of persons with GSD, 30% had a cholecystectomy. Mortality was higher compared with the whole EHR sample. Persons with cholecystectomy were less likely to have non-colorectal digestive cancer or to die.
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Affiliation(s)
- Aynur Unalp-Arida
- Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Two Democracy Plaza, Room 6009, 6707 Democracy Blvd., Bethesda, MD, 20892-5458, USA
| | - Jane S Der
- Social & Scientific Systems, Inc., a DLH Holdings Corp company, 8757 Georgia Avenue, 12th floor, Silver Spring, MD, 20910, USA
| | - Constance E Ruhl
- Social & Scientific Systems, Inc., a DLH Holdings Corp company, 8757 Georgia Avenue, 12th floor, Silver Spring, MD, 20910, USA.
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15
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Martin WT, Ball J, Patterson AK, Snyder KB, Bonds M, Stewart K, Sarwar Z, Raines AR, Cross A. Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm. Am J Surg 2023; 226:835-839. [PMID: 37481409 DOI: 10.1016/j.amjsurg.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure. METHODS Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression. RESULTS Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7-22.9). CONCLUSION Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.
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Affiliation(s)
| | - Jonathan Ball
- University of Oklahoma General Surgery Department, USA.
| | | | | | - Morgan Bonds
- University of Oklahoma General Surgery Department, USA.
| | | | - Zoona Sarwar
- University of Oklahoma General Surgery Department, USA.
| | | | - Alisa Cross
- University of Oklahoma General Surgery Department, USA.
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16
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Mahjoubi MF, Dhaou AB, Maatouk M, Essid N, Rezgui B, Karoui Y, Moussa MB. Acute cholecystitis in pregnant women: A therapeutic challenge in a developing country center. Ann Hepatobiliary Pancreat Surg 2023; 27:388-393. [PMID: 37915236 DOI: 10.14701/ahbps.23-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 11/03/2023] Open
Abstract
Backgrounds/Aims Acute cholecystitis is a rare condition in pregnant women, potentially affecting the maternal and fetal prognosis. Our aim was to report the main clinical and paraclinical features of acute cholecystitis during pregnancy and therapeutic modalities. Methods We conducted a case series analysis recording pregnant patients with acute cholecystitis admitted to our surgery department over a period of 11 years. We collected clinical data, paraclinical features, and management modalities related to cholecystitis. Results There were 47 patients. Twenty-eight percent was in the first trimester of pregnancy, 40% in the second, and 32% in the third trimester. Abdominal pain was located in the right hypochondrium in 75% of cases. Fever was noted in 21% of cases. C-reactive protein was elevated in 39% of patients. Cholestasis markers were high in four patients. Abdominal ultrasound showed a distended gallbladder in 39 patients, with thickened wall in 34 patients, and gallbladder lithiasis in all cases. No patient had a dilated main bile duct. All patients received intravenous antibiotic therapy. Tocolysis was indicated in 32 patients. Laparoscopic cholecystectomy was performed in 32 cases (68%), and open cholecystectomy in 15 cases (32%). Postoperative course was uneventful in 42 patients, and complicated in 5 patients. Rate of complications was statistically higher after open cholecystectomy (p = 0.003). Morbidity rate was higher in the third trimester (p = 0.003). Conclusions Delay in the diagnosis of acute cholecystitis during pregnancy can lead to serious complications. Management is based on antibiotic therapy and cholecystectomy. Laparoscopic cholecystectomy appears to be less morbid than open cholecystectomy.
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Affiliation(s)
- Mohamed Fares Mahjoubi
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Anis Ben Dhaou
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Maatouk
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nada Essid
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Bochra Rezgui
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yasser Karoui
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mounir Ben Moussa
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Arora A, Jack K, Kumar AV, Borad M, Girardo ME, De Filippis E, Yang P, Dinu V. Genome-Wide Association Study of Gallstone Disease Identifies Novel Candidate Genomic Variants in a Latino Community of Southwest USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01867-0. [PMID: 38015333 DOI: 10.1007/s40615-023-01867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Gallstone disease (GSD) is a prevalent health condition that impacts many adults and is associated with presence of stones in gallbladder cavity that results in inflammation, pain, fever, nausea and vomiting. Several genome-wide association studies (GWAS) in the past have identified genes associated with GSD but only a few were focused on Latino population. To identify genetic risk factors for GSD in Latino population living in the Southwest USA we used self-reported clinical history, physical and lab measurements data in Sangre Por Salud (SPS) cohort and identified participants with and without diagnosis of GSD. We performed a GWAS on this phenotype using GSD cases matched to normal controls based on a tight criterion. We identified several novel loci associated with GSD as well as loci that were previously identified in past GWAS studies. The top 3 loci (MATN2, GPRIN3, GPC6) were strongly associated with GSD phenotype in our combined analysis and a sex stratified analysis results in females were closest to the overall results reflecting a general higher disease prevalence in females. The top identified variants in MATN2, GPRIN3, and GPC6 remain unchanged after local ancestry adjustment in SPS Latino population. Follow-up pathway enrichment analysis suggests enrichment of GO terms that are associated with immunological pathways; enzymatic processes in gallbladder, liver, and gastrointestinal tract; and GSD pathology. Our findings suggest an initial starting point towards better and deeper understanding of differences in gallstone disease pathology, biological mechanisms, and disease progression among Southwest US Latino population.
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Affiliation(s)
- Amit Arora
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA.
| | - Khadijah Jack
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Ashok V Kumar
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Mitesh Borad
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Marlene E Girardo
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | | | - Ping Yang
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Valentin Dinu
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
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Wu S, Zhu W, Wang X, Zhao K, He B, Peng Z, Yang J. Relationship between different intestinal microflora and cholelithiasis: A systematic review and meta-analysis. Asian J Surg 2023; 46:4780-4782. [PMID: 37328378 DOI: 10.1016/j.asjsur.2023.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/19/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Shile Wu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China; Soochow University, Suzhou, 21500, Jiangsu Province, China
| | - Wenjun Zhu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Xinsheng Wang
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Kechang Zhao
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Beibei He
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Zhe Peng
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Jinyu Yang
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
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May C, Sodickson A. Leveraging Dual-Energy Computed Tomography to Improve Emergency Radiology Practice. Radiol Clin North Am 2023; 61:1085-1096. [PMID: 37758358 DOI: 10.1016/j.rcl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Dual-energy computed tomography affords emergency radiologists with important tools to aid in the detection and discrimination of commonly encountered ED pathologies. In doing so, it can increase the speed of diagnosis and diagnostic certainty while sparing patients potentially unnecessary downsteam workups and radiation exposure. This article demonstrates these clinical benefits through a case-based approach.
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Affiliation(s)
- Craig May
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Aaron Sodickson
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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20
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Franceschi P, Brandi N, Pecorelli A, Vitale G, Cescon M, Renzulli M. Reverse Mirizzi Syndrome. Radiol Case Rep 2023; 18:4157-4159. [PMID: 37745768 PMCID: PMC10511724 DOI: 10.1016/j.radcr.2023.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [<1.2 mg/dL]; conjugated 1.06 mg/dL [<0.3 mg/dL]) and cholestasis (GGT 78 U/L [<50 U/L]; ALP 200 U/L [<50 U/L]). Transabdominal ultrasound was limited by aerobilia due to the cholecystojejuno-anastomosis. Subsequent basal CT scan revealed an impacted stone within the patient's native common bile duct (CBD). Aerobilia in intrahepatic bile ducts and gallbladder was reported. Magnetic Resonance cholangiopancreatography confirmed the gallstone in the CBD compressing cystic duct and common hepatic duct, with dilation of the upstream bile ducts. Furthermore, the native CBD was obstructed by other gallstones. In Mirizzi syndrome, gallstones impacted in gallbladder's Hartmann's pouch or cystic duct extrinsically compress CBD. We suggest naming the present condition "Reverse Mirizzi Syndrome" (Renzulli Matteo Syndrome, RMS) because it is the exact opposite of Mirizzi syndrome.
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Affiliation(s)
- Paola Franceschi
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giovanni Vitale
- Unit of Internal Medicine for the Treatment of Severe Organ Failure, Surgical Department of Digestive, Hepatic and Endocrine-Metabolic Diseases, IRCSS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Hepatobiliary Surgery and Organ Transplantation, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via G. Massarenti 9, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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21
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Papageorge MV, de Geus SWL, Woods AP, Ng SC, McAneny D, Tseng JF, Kenzik KM, Sachs TE. The Evaluation of Gallstone Disease in the Year Before Pancreatic Cancer Diagnosis. J Surg Res 2023; 291:282-288. [PMID: 37481963 DOI: 10.1016/j.jss.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/04/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Patients with pancreatic cancer can present with a variety of insidious abdominal symptoms, complicating initial diagnosis. Early symptoms of pancreatic cancer often mirror those associated with gallstone disease, which has been demonstrated to be a risk factor for this malignancy. This study aims to compare the incidence of gallstone disease in the year before diagnosis of pancreatic ductal adenocarcinoma (PDAC) as compared to the general population, and evaluate the association of gallstone disease with stage at diagnosis and surgical intervention. METHODS Patients with PDAC were identified from SEER-Medicare (2008-2015). The incidence of gallstone disease (defined as cholelithiasis, cholecystitis and/or cholecystectomy) in the 1 year before cancer diagnosis was compared to the annual incidence in an age-matched, sex-matched, and race-matched noncancer Medicare cohort. RESULTS Among 14,654 patients with PDAC, 4.4% had gallstone disease in the year before cancer diagnosis. Among the noncancer controls (n = 14,654), 1.9% had gallstone disease. Both cohorts had similar age, sex and race distributions. PDAC patients with gallstone disease were diagnosed at an earlier stage (stage 0/I-II, 45.8% versus 38.1%, P < 0.0001) and a higher proportion underwent resection (22.7% versus 17.4%, P = 0.0004) compared to patients without gallstone disease. CONCLUSIONS In the year before PDAC diagnosis, patients present with gallstone disease more often than the general population. Improving follow-up care and differential diagnosis strategies may help combat the high mortality rate in PDAC by providing an opportunity for earlier stage of diagnosis and earlier intervention.
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Affiliation(s)
- Marianna V Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts. https://twitter.com/MPapageorge_MD
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts
| | - Alison P Woods
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. https://twitter.com/AlisonMPease21
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts. https://twitter.com/TsengJennifer
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, Massachusetts.
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22
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Krawczyk M, Kułaga Z, Niewiadomska O, Jankowska I, Lebensztejn D, Więcek S, Socha P. Are children with gallstone disease more overweight? Results of a matched case-control analysis. Clin Res Hepatol Gastroenterol 2023; 47:102204. [PMID: 37678608 DOI: 10.1016/j.clinre.2023.102204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Gallstone disease (GD) is increasingly common among children, possibly caused by an unhealthy food environment and the associated unhealthy lifestyle. In this study, we investigate the association between body weight and gallstone risk in a cohort of prospectively recruited children with GD. METHODS We analysed 188 children with gallstones (50.0% girls, median age 9.8 years) and 376 children without stones who were age- and gender-matched to cases in a ratio of 2:1. Cases were prospectively recruited at three Polish university centres (Warsaw, Katowice and Bialystok). Gallstones were diagnosed by either abdominal sonography or by a history of cholecystectomy. Matched controls without gallstones were selected from 22,412 children taking part in nationally representative Polish health surveys (OLA and OLAF studies) which provided height and weight data for randomly selected pre-school (2.5-6 years) and school aged (7-18 years) children and adolescents. RESULTS Analysis of the age- and gender-matched cases and controls demonstrated that patients with GD had significantly higher BMI (P = 0.02) and BMI z-score (P < 0.01) than children without stones. Children with gallstones were more frequently overweight (35.6%, P < 0.01) and obese (12.2%, P < 0.01) than controls (18.4% and 6.7%, respectively). Regression analyses showed that BMI, BMI z-score, overweight and obesity were all associated with increased GD risk (all P < 0.05). CONCLUSIONS Overweight and obesity are common in children with cholelithiasis. Given the epidemic of obesity in children we should expect an increasing prevalence of gallstones and stone-related complications in youths and in adults.
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Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, Homburg 66421, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Zbigniew Kułaga
- Public Health Department of the Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Olga Niewiadomska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Irena Jankowska
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Bialystok, Poland
| | - Sabina Więcek
- Department of Pediatrics, Silesian Medical Academy, Katowice, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
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23
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Jiménez Gómez J, Jiménez Arribas P, Betancourth Alvarenga J, Santiago Martínez S, San Vicente Vela B, Gaspar Pérez M, Roberto Güizzo J, Esteva Miró C, Sánchez Vázquez B, Álvarez García N, Núñez García B. Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in Pediatrics. Cir Pediatr 2023; 36:186-190. [PMID: 37818901 DOI: 10.54847/cp.2023.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION In spite of the increase in the prevalence of cholelithiasis in the last decades, no recommendations regarding the best treatment of acute calculous cholecystitis (AC) in Pediatrics have been developed. CLINICAL CASE 4-year-old, 20kg male patient with no significant history referred to our institution as a result of abdominal sepsis. The blood count showed leukocytosis, with normal hemoglobin and bilirubin levels, and a normal liver function. The abdominal ultrasonography revealed cholelithiasis, gallbladder hydrops, and an inflammatory process compatible with appendicular plastron. In the diagnostic laparoscopy, the appendix was macroscopically normal, and acute cholecystitis was observed. Given the patient's situation, and in cooperation with the General Surgery Department, laparoscopic cholecystectomy was carried out. The patient recovered uneventfully on hospitalization day 5 under piperacillin-tazobactam treatment. DISCUSSION There are no recommendations regarding AC treatment in children. In septic patients, cooperation between general and pediatric surgeons allows urgent cholecystectomy to be considered as a safe option.
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Affiliation(s)
- J Jiménez Gómez
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - P Jiménez Arribas
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | | | - S Santiago Martínez
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - B San Vicente Vela
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - M Gaspar Pérez
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - J Roberto Güizzo
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - C Esteva Miró
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - B Sánchez Vázquez
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - N Álvarez García
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
| | - B Núñez García
- Pediatric Surgery Department. Hospital Universitari Parc Taulí. Sabadell (Spain)
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24
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Gundogdu R, Erkan S, Kus M, Aytac HO, Yabanoglu H. Effectiveness of simultaneous umbilical hernia primary repair with laparoscopic cholecystectomy. North Clin Istanb 2023; 10:556-559. [PMID: 37829743 PMCID: PMC10565757 DOI: 10.14744/nci.2022.02700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/04/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Umbilical hernia repair can be easily performed simultaneously with laparoscopic cholecystectomy. The use of mesh is recommended for hernias larger than 1 cm. In this study, patients with primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy were evaluated. It aimed to present the effectiveness of this method and the effect of body mass index (BMI) on treatment results. METHODS The records of patients who underwent primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy between 2014 and 2021 were reviewed retrospectively. Patients' age, gender, BMI, length of hospital stay, recurrence and reoperation information, and follow-up times were analyzed. The patients were examined in three groups according to their BMI, and the effect of BMI on treatment was investigated. RESULTS patients were included in the study. Median values of the patients for age, BMI, hospitalization, and follow-up were 63 (28-94), 31 (20-51) kg/m2, 1 (1-25) days, and 23 (0.6-76) months, respectively. Recurrence was detected in 8 patients. BMI was <25 in one patient with recurrence and >30 in 5 patients. There was no significant correlation between length of stay, number of relapse and reoperation, and BMI (p>0.05). CONCLUSION In our study, the recurrence rate was found to be higher than the studies reported with the use of mesh, and most of the patients with recurrence are obese, although it is not statistically significant. If the recurrence rate is acceptable, we believe that repair with primary suture is feasible in umbilical hernia.
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Affiliation(s)
- Ramazan Gundogdu
- Department of General Surgery, Baskent University Dr. Turgut Noyan Training and Research Hospital, Adana, Turkiye
| | - Serkan Erkan
- Department of General Surgery, Baskent University Dr. Turgut Noyan Training and Research Hospital, Adana, Turkiye
| | - Murat Kus
- Department of General Surgery, Baskent University Dr. Turgut Noyan Training and Research Hospital, Adana, Turkiye
| | - Huseyin Ozgur Aytac
- Department of General Surgery, Baskent University Dr. Turgut Noyan Training and Research Hospital, Adana, Turkiye
| | - Hakan Yabanoglu
- Department of General Surgery, Baskent University Dr. Turgut Noyan Training and Research Hospital, Adana, Turkiye
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25
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Salari N, Hasheminezhad R, Heidarisharaf P, Khaleghi AA, Azizi AH, Shohaimi S, Mohammadi M. The global prevalence of gallstones in pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100237. [PMID: 37711873 PMCID: PMC10497987 DOI: 10.1016/j.eurox.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023] Open
Abstract
Background Gallstone disease is the second most common non-gynecological disease that may require surgical intervention during pregnancy. This study investigates the global prevalence of gallstones in pregnancy through a systematic review and meta-analysis. Methods A systematic review and meta-analysis of studies that reported the global prevalence of gallstones in pregnancy was conducted. PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar were searched for studies published up to September 2022. Results In a review of 31 studies with a sample size of 190,714 people, the I2 heterogeneity test showed high heterogeneity (I2 = 98.8%). Therefore, the random effects method was used to analyze the results. The prevalence of gallstones was reported as 3.6% (95% CI: 1.9-6.7%). The highest prevalence of gallstones by continent was reported in America, at 6.8% (95% CI: 4.2-10.8%). The Egger test showed no evidence of publication bias (p = 0.609). Conclusion Based on the results of this study, health policymakers should emphasize to the target community and the medical staff dealing with pregnant women the importance of screening for gallstones during pregnancy.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Razie Hasheminezhad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Asghar Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | | | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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26
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Al-Janabi MH, Hussein BYA, Kahwaji JN, Haidar M, Mortada A, Salloum R. Idiopathic eosinophilic cholecystitis with cholelithiasis: Two rare cases report. Int J Surg Case Rep 2023; 110:108714. [PMID: 37647760 PMCID: PMC10509788 DOI: 10.1016/j.ijscr.2023.108714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Eosinophilic cholecystitis is an unusual condition in which more than 90 % of the inflammatory infiltrate in the gallbladder wall is comprised of eosinophils. The pathogenesis of eosinophilic cholecystitis is still unknown, but in some cases, it is related to hyper-eosinophilic syndrome, parasitosis, infections, and drugs. CASE PRESENTATION We described two cases in which a woman aged 27 years and a man aged 30 years presented with acute and chronic cholecystitis symptoms, respectively. The ultrasound revealed calculous cholecystitis. The cholecystectomy was performed, and the pathological examination of the surgical specimen revealed eosinophilic cholecystitis. CLINICAL DISCUSSION Eosinophilic cholecystitis is a rare disease of the gallbladder. It accounts for 0.25 to 6.4 % of cholecystitis cases. It is characterized by eosinophils infiltration in the lamina propria and the muscle layer. There are no specific symptoms of this disease; it presents as typical cholecystitis. The histopathological investigation is the gold standard for diagnosing eosinophilic cholecystitis, and cholecystectomy is the ultimate treatment for it. CONCLUSION Eosinophilic cholecystitis is a rare condition characterized by acute cholecystitis with eosinophilic infiltration of the gallbladder. In patients with eosinophilic cholecystitis, a comprehensive assessment of the underlying causes is recommended.
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Affiliation(s)
| | | | | | - Maen Haidar
- Department of General Surgery, Tishreen University Hospital, Latakia, Syria
| | - Aiman Mortada
- Department of General Surgery, Tishreen University Hospital, Latakia, Syria
| | - Rabab Salloum
- Department of Pathology, Tishreen University Hospital, Latakia, Syria
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27
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Fujita N, Yasuda I, Endo I, Isayama H, Iwashita T, Ueki T, Uemura K, Umezawa A, Katanuma A, Katayose Y, Suzuki Y, Shoda J, Tsuyuguchi T, Wakai T, Inui K, Unno M, Takeyama Y, Itoi T, Koike K, Mochida S. Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol 2023; 58:801-833. [PMID: 37452855 PMCID: PMC10423145 DOI: 10.1007/s00535-023-02014-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The Japanese Society of Gastroenterology first published evidence-based clinical practice guidelines for cholelithiasis in 2010, followed by a revision in 2016. Currently, the revised third edition was published to reflect recent evidence on the diagnosis, treatment, and prognosis of cholelithiasis conforming to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Following this revision, the present English version of the guidelines was updated and published herein. The clinical questions (CQ) in the previous version were reviewed and rearranged into three newly divided categories: background questions (BQ) dealing with basic background knowledge, CQ, and future research questions (FRQ), which refer to issues that require further accumulation of evidence. Finally, 52 questions (29 BQs, 19 CQs, and 4 FRQs) were adopted to cover the epidemiology, pathogenesis, diagnosis, treatment, complications, and prognosis. Based on a literature search using MEDLINE, Cochrane Library, and Igaku Chuo Zasshi databases for the period between 1983 and August 2019, along with a manual search of new information reported over the past 5 years, the level of evidence was evaluated for each CQ. The strengths of recommendations were determined using the Delphi method by the committee members considering the body of evidence, including benefits and harms, patient preference, and cost-benefit balance. A comprehensive flowchart was prepared for the diagnosis and treatment of gallbladder stones, common bile duct stones, and intrahepatic stones, respectively. The current revised guidelines are expected to be of great assistance to gastroenterologists and general physicians in making decisions on contemporary clinical management for cholelithiasis patients.
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Affiliation(s)
- Naotaka Fujita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Miyagi Medical Check-up Plaza, 1-6-9 Oroshi-machi, Wakabayashi-ku, Sendai, Miyagi, 984-0015, Japan.
| | - Ichiro Yasuda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Itaru Endo
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroyuki Isayama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takuji Iwashita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiharu Ueki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kenichiro Uemura
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akiko Umezawa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akio Katanuma
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yu Katayose
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yutaka Suzuki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Junichi Shoda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshio Tsuyuguchi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshifumi Wakai
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuo Inui
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Michiaki Unno
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yoshifumi Takeyama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takao Itoi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Satoshi Mochida
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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28
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Chuwa AH. Huge solitary gallstone complicated with liver cirrhosis in a middle-aged woman: case report. Ann Med Surg (Lond) 2023; 85:4539-4542. [PMID: 37663725 PMCID: PMC10473310 DOI: 10.1097/ms9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/16/2023] [Indexed: 09/05/2023] Open
Abstract
Background Gallstones are increasingly becoming a common diagnosis in hospitals across the continents, with predominance in women. Patients suspected of a gallstone disease require thorough evaluation including endoscopic ultrasound, magnetic resonance imaging, or magnetic resonance cholangiography. A delayed or missed diagnosis is associated with serious complications and poor prognosis. Case presentation A 44-year-old female patient presented with fever, vomiting, hypochondria, and epigastric pain for 10 days. Clinical examination showed jaundice and tenderness at the right hypochondriac region. Blood analysis revealed elevated bilirubin, alkaline phosphatase, and white blood cells. The patient was sent for a computed tomography (CT) scan which showed a grossly enlarged liver about 17.2 cm in length and a hypo-attenuating mass in the gallbladder fossa that enhanced moderately and heterogeneously following intravenous contrast administration. Dilated intrahepatic biliary ducts were also appreciated. Explorative laparotomy was performed and revealed an enlarged, cirrhotic-appearing liver, a thickened gallbladder, and a whitish-yellow gallstone about 3 cm in the largest diameter situated at its neck. No isolated tumour was found. Clinical discussion Although gallstone disease is very common, misdiagnosis still occurs especially in low and lower-middle-income countries. Inadequate evaluation and increased utilization of CT in emergency and surgical departments are the contributing factors for a missed diagnosis. Conclusions A missed gallstone disease occurs due to various factors including inappropriate standard operating procedures, which set a CT scan as the first imaging test for all internal conditions. This case report presents the appropriate approach to achieving the diagnosis of a gallstone disease before surgical intervention.
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Affiliation(s)
- Agapiti Hipoliti Chuwa
- Department of Medical Physiology, Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
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29
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Lim KPK, Lee AJL, Jiang X, Teng TZJ, Shelat VG. The link between Helicobacter pylori infection and gallbladder and biliary tract diseases: A review. Ann Hepatobiliary Pancreat Surg 2023; 27:241-250. [PMID: 37357161 PMCID: PMC10472116 DOI: 10.14701/ahbps.22-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 06/27/2023] Open
Abstract
Helicobacter pylori is a gram-negative pathogen commonly associated with peptic ulcer disease and gastric cancer. H. pylori infection has also been reported in cholelithiasis, cholecystitis, gallbladder polyps, and biliary tract cancers. However, the association between H. pylori and gallbladder and biliary tract pathologies remains unclear due to the paucity of literature. In response to the current literature gap, we aim to review and provide an updated summary of the association between H. pylori with gallbladder and biliary tract diseases and its impact on their clinical management. Relevant peer-reviewed studies were retrieved from Medline, PubMed, Embase, and Cochrane databases. We found that H. pylori infection was associated with cholelithiasis, chronic cholecystitis, biliary tract cancer, primary sclerosing cholangitis, and primary biliary cholangitis but not with gallbladder polyps. While causal links have been reported, prospective longitudinal studies are required to conclude the association between H. pylori and gallbladder pathologies. Clinicians should be aware of the implications that H. pylori infection has on the management of these diseases.
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Affiliation(s)
- Klay Puay Khim Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Aaron Jia Loong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiuting Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Wang G, Zhang H, Zhou Z, Jin W, Zhang X, Ma Z, Wang X. AQP3-mediated activation of the AMPK/SIRT1 signaling pathway curtails gallstone formation in mice by inhibiting inflammatory injury of gallbladder mucosal epithelial cells. Mol Med 2023; 29:116. [PMID: 37641009 PMCID: PMC10463418 DOI: 10.1186/s10020-023-00712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Inflammatory injury of gallbladder mucosal epithelial cells affects the development of cholelithiasis, and aquaporin 3 (AQP3) is an important regulator of inflammatory response. This study reports a mechanistic insight into AQP3 regulating gallstone formation in cholelithiasis based on high-throughput sequencing. METHODS A mouse model of cholelithiasis was induced using a high-fat diet, and the gallbladder tissues were harvested for high-throughput sequencing to obtain differentially expressed genes. Primary mouse gallbladder mucosal epithelial cells were isolated and induced with Lipopolysaccharides (LPS) to mimic an in vitro inflammatory injury environment. Cell biological phenotypes were detected by TdT-mediated dUTP Nick-End Labeling (TUNEL) assay, flow cytometry, Cell Counting Kit-8 (CCK-8) assay, and Trypan blue staining. In addition, enzyme linked immunosorbent assay (ELISA) determined the production of inflammatory factors in mouse gallbladder mucosa. RESULTS Whole-transcriptome sequencing data analysis identified 489 up-regulated and 1007 down-regulated mRNAs. Bioinformatics analysis revealed that AQP3 was significantly down-regulated in mice with cholelithiasis. AQP3 might also confer an important role in LPS-induced gallbladder mucosal injury. Overexpression of AQP3 activated the AMPK (adenosine monophosphate-activated protein kinase) / SIRT1 (sirtuin-1) signaling pathway to reduce LPS-induced inflammatory injury of the gallbladder mucosa epithelium, thereby ameliorating gallbladder damage and repressing gallstone formation in mice. CONCLUSION Data from our study highlight the inhibitory role of AQP3 in gallbladder damage and gallstone formation in mice by reducing inflammatory injury of gallbladder mucosal epithelial cells, which is achieved through activation of the AMPK/SIRT1 signaling pathway.
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Affiliation(s)
- Ganggang Wang
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Hao Zhang
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijie Zhou
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Wenzhi Jin
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Xin Zhang
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zenghui Ma
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Xiaoliang Wang
- Department of Hepatobiliary Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
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Jia F, Ma Y, Liu Y. Association of milk consumption with the incidence of cholelithiasis disease in the US adult population. BMC Public Health 2023; 23:1639. [PMID: 37635228 PMCID: PMC10463673 DOI: 10.1186/s12889-023-16615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Cholelithiasis is a common digestive system disease that imposes major burden on patients and society. Investigating the relationship between dietary factors and cholelithiasis risk can provide a basis for disease prevention. Previous studies on milk intake and cholelithiasis incidence have been limited.Therefore, the aim of our study was to assess the association between milk consumption and the incidence of cholelithiasis in males and females. METHODS We selected 14,722 adults (≥ 18 years old) from National Center for Health Statistics (NHANSE) 2017-2020, and collected general characteristics of patients in the database, such as age, gender, race and body mass index (BMI), as well as dietary information (milk consumption). The occurrence of cholelithiasis was used as the outcome event, and the group was divided into cholelithiasis and non-cholelithiasis groups according to the outcome event. We used logistic regression models in generalized linear model (GLM) functions, controlling for demographic, lifestyle, and dietary factors, to estimate the association between milk intake and the incidence of cholelithiasis in males and females. RESULTS A total of 14,722 adults were included. In the present study, the overall weighted prevalence of cholelithiasis was 10.96%, with 15.18% and 6.48% prevalence in females and males, respectively. Compared to infrequent milk intake, frequent milk intake (once a week or more) in females was associated with reduced cholelithiasis risk (OR 0.74, 95% CI 0.61-0.90). Daily milk intake in males was also related to lower cholelithiasis risk (OR 0.69-0.82). As adjusted variables increased in the models, predictive performance was improved (AUC 0.711 in females, 0.730 in males). CONCLUSIONS Appropriate milk intake may correlate with decreased cholelithiasis risk. Our study provides a basis for dietary interventions against gallstones, but prospective studies are needed to verify the results.
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Affiliation(s)
- Feng Jia
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yu Ma
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China.
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Coogan AC, Williams MD, Krishnan V, Skertich NJ, Becerra AZ, Sarran M, Schimpke S, Torquati A, Omotosho P. Ursodiol Prescriptions Following Bariatric Surgery: National Prescribing Trends and Outcomes. Obes Surg 2023; 33:2361-2367. [PMID: 37392353 DOI: 10.1007/s11695-023-06710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Rapid weight loss after bariatric surgery is a risk factor for gallstone development. Numerous studies have shown that ursodiol after surgery decreases rates of gallstone formation and cholecystitis. Real-world prescribing practices are unknown. This study aimed to examine prescription patterns for ursodiol and reassess its impact on gallstone disease using a large administrative database. METHODS The Mariner database (PearlDiver, Inc.) was queried using Current Procedural Terminology codes for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2011 and 2020. Only patients with International Classification of Disease codes for obesity were included. Patients with pre-operative gallstone disease were excluded. The primary outcome was gallstone disease within 1 year, which was compared between patients who did and did not receive an ursodiol prescription. Prescription patterns were also analyzed. RESULTS Three hundred sixty-five thousand five hundred patients fulfilled inclusion criteria. Twenty-eight thousand seventy-five (7.7%) patients were prescribed ursodiol. There was a statistically significant difference in development of gallstones (p < 0.001), development of cholecystitis (p = .049), and undergoing cholecystectomy (p < 0.001). There was a statistically significant decrease in the adjusted odds ratio (aOR) for the development of gallstones (aOR 0.81, 95% CI: 0.74, 0.89), development of cholecystitis (aOR 0.59, 95% CI: 0.36, 0.91), and undergoing cholecystectomy (aOR 0.75, 95% CI: 0.69, 0.81). CONCLUSION Ursodiol significantly decreases the odds of development of gallstones, cholecystitis, or cholecystectomy within 1 year following bariatric surgery. These trends hold true when analyzing RYGB and SG separately. Despite the benefit of ursodiol, only 10% of patients received an ursodiol prescription postoperatively in 2020.
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Affiliation(s)
- Alison C Coogan
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA.
| | - Michael D Williams
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Vaishnavi Krishnan
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Nicholas J Skertich
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Marc Sarran
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Scott Schimpke
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, 1750 W Harrison, Suite 775, Chicago, IL, 60612, USA
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Ciecko C, Okut H, Lancaster B, Schwasinger-Schmidt T. Prevalence of elevated alkaline phosphatase levels among post-bariatric surgery patients. Langenbecks Arch Surg 2023; 408:285. [PMID: 37479912 DOI: 10.1007/s00423-023-03021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Little is known about the prevalence of elevated alkaline phosphatase in post-bariatric surgery patients due to under-utilization of this test after surgery. Elevated alkaline phosphatase levels are caused by hepatobiliary disease or bone resorption, which can lead to gallstones and osteoporosis. Early, post-operative measurement of alkaline phosphatase can prevent complications, thus reducing morbidity and overall healthcare costs. The purpose of this study was to determine the prevalence of elevated alkaline phosphatase levels among post-operative bariatric surgery patients. METHODS This was a retrospective study of patients 18 years or older, who underwent laparoscopic sleeve gastrectomy (LSG) at a Midwestern Weight Management Clinic between January 1, 2002 and December 31, 2020. Alkaline phosphatase levels, weight, body mass index (BMI), gamma-glutamyl transferase (GGT), parathyroid hormone (PTH), calcitriol, and calcitonin, vitamin D and multivitamin supplementation were measured at baseline, 3, 6, and 12 months post-surgery. RESULTS Two hundred thirty patients with mean age of 47 years and BMI of 44.6 were included with 80.9% (n = 186) female. Alkaline phosphatase was elevated relative to baseline for 36.1% of patients (n = 52) at 3 months post-surgery, 42.4% of patients (n = 56) at 6 months, and 43.3% of patients (n = 45) at 12 months (p < 0.001). There were six cases of documented cholelithiasis post-surgery. CONCLUSION A significant proportion of participants experienced elevations in alkaline phosphatase following surgery, indicating that the prevalence of gallbladder pathology and bone resorption may be higher than previously thought. This merits additional investigation into these complications post-operatively to determine prevalence and avoid excess morbidity.
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Affiliation(s)
- Claudius Ciecko
- Office of Research, University of Kansas School of Medicine Wichita, 1010 North Kansas, Wichita, KS, 67214, USA.
| | - Hayrettin Okut
- Office of Population Health, University of Kansas School of Medicine Wichita, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Brent Lancaster
- Wichita Surgical Specialists, 818 N Emporia St, Suite 200, Wichita, KS, 67214, USA
| | - Tiffany Schwasinger-Schmidt
- Office of Internal Medicine, University of Kansas School of Medicine Wichita, 1010 North Kansas, Wichita, KS, 67214, USA
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Jiang T, Zhang H, Yin X, Cai Z, Zhao Z, Mu M, Liu B, Shen C, Zhang B, Yin Y. The necessity and safety of simultaneous cholecystectomy during gastric surgery for patients with asymptomatic cholelithiasis. Expert Rev Gastroenterol Hepatol 2023; 17:1053-1060. [PMID: 37795528 DOI: 10.1080/17474124.2023.2264782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES The incidence of cholelithiasis is higher among individuals who have undergone gastric surgery. The benefits of concomitant gallbladder removal in asymptomatic gallstone patients remain uncertain. The aim was to investigate the necessity and safety of simultaneous cholecystectomy in this particular patient population. METHODS We performed a systematic review and meta-analysis to assess the incidence of asymptomatic cholelithiasis converting to symptomatic after gastric surgery and the complication rate associated with simultaneous cholecystectomy. PubMed, Embase, and the Cochrane Library were searched for relevant articles published until 10 March 202210 March 2022. RESULTS Patients with asymptomatic cholelithiasis after gastric surgery were at a higher risk of developing symptomatic cholelithiasis compared to those without cholelithiasis (relative risk [RR] 2.28, 95% confidence interval [CI] 1.23-4.25) and those with unknown gallbladder conditions (RR 2.70, 95% CI 1.54-4.73). Additionally, patients who underwent simultaneous cholecystectomy did not face a higher risk of complications compared to those who only underwent gastric surgery (RR 0.86, 95% CI 0.48-1.53). CONCLUSIONS Simultaneous cholecystectomy is both necessary and safe for patients with asymptomatic cholelithiasis undergoing gastric surgery. It is crucial to assess the gallbladder's condition before gastric surgery, and if the gallbladder status is unknown, simultaneous cholecystectomy should be avoided.
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Affiliation(s)
- Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Haidong Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Xiaonan Yin
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Zhou Zhao
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Baike Liu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Yuan Yin
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
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Viana FB, Viana JB, Seabra Beraldo PS. Prophylactic cholecystectomy in individuals with spinal cord injury: A systematic review. J Spinal Cord Med 2023; 46:649-657. [PMID: 36355833 PMCID: PMC10274514 DOI: 10.1080/10790268.2022.2144026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Spinal cord injury (SCI) is associated with several gastrointestinal disorders, and the prevalence of cholelithiasis is high in this population. Because individuals with SCI may have atypical symptoms and more advanced disease, some treatment centers advocate prophylactic cholecystectomy for patients with SCI and gallstone disease. OBJECTIVE To systematically review the existence and quality of studies on prophylactic cholecystectomy in individuals with SCI and cholelithiasis. METHODS A systematic search of literature up to July 10, 2022 was conducted in accordance with PRISMA guidelines using the Medline, Cochrane, and Web of Science databases. Keywords used were "cholecystectomy," "gallbladder," "cholelithiasis," "gallstone," and "spinal cord injury." RESULTS The search identified 118 articles, of which 4 met the inclusion criteria. All these were retrospective observational studies. Prophylactic cholecystectomy was performed in 4-16.5% of the participants. The causes of cholecystectomy were chronic cholecystitis with biliary colic (44.5-63.5%), acute cholecystitis (4-26%), choledocholithiasis (6-11%) and pancreatitis (2-6%). Operative times, conversion rates, estimated blood loss, severity of complications, morbidity and mortality did not differ significantly between individuals with SCI and neurologically able individuals. CONCLUSION No prospective cohort studies comparing prophylactic cholecystectomy with conservative management in individuals with SCI and gallstone disease have been conducted. Therefore, there is no robust evidence to support prophylactic cholecystectomy and further studies are required.
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Rao M, Ai X, Huang Z. The Causal Effects of Cholelithiasis on Acute Pancreatitis and Pancreatic Cancer: A Large Sample Size Mendelian Randomization Analysis. Recent Pat Anticancer Drug Discov 2023; 18:PRA-EPUB-132438. [PMID: 37563810 DOI: 10.2174/1574892818666230609121409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The aim of two-sample Mendelian randomization (MR) with a large sample size was to explore the causal cholelithiasis impact on acute pancreatitis and pancreatic cancer. METHODS We performed the two-sample MR analysis with two models. Publicly available summary- level information for cholelithiasis was acquired from the Genome-Wide Summary Association Studies (GWAS) of FinnGen Biobank. The inverse variance weighted (IVW) method was the main method to obtain the MR estimates. Other methods were also used as supplementary methods, including MR-Egger, maximum likelihood, MR-Robust Adjusted Profile Score (MR-RAPS), weighted median, penalised weighted median method, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) method. RESULTS After the selection of genetic instrumental variables (IVs), 11 single nucleotide polymorphisms (SNPs) (Model 1) and 22 SNPs (Model 2) were used to explore the effect of cholelithiasis on acute pancreatitis, and 10 SNPs (Model 1) and 24 SNPs (Model 2) on pancreatic cancer. The findings obtained by the fixed-effect IVW method with both Model 1 and Model 2 showed that genetically predicted cholelithiasis was significantly related to the elevated acute pancreatitis risk (Model 1: OR: 1.001, 95% CI: 1.000-1.002, p <0.001; Model 2: OR: 1.001, 95% CI: 1.000-1.002, p <0.001). Moreover, cholelithiasis would also raise the pancreatic cancer risk (Model 1: OR: 1.676, 95% CI: 1.228-2.288, p = 0.001; Model 2: OR: 1.432, 95% CI: 1.116-1.839, p = 0.005). CONCLUSION Genetically predicted cholelithiasis was significantly related to the elevated risk of acute pancreatitis and pancreatic cancer. More attention should be paid to patients with cholelithiasis for the primary prevention of pancreatic-related diseases.
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Affiliation(s)
- Moshi Rao
- Department of Gastroenterology, Zhebei Mingzhou Hospital, 313000, Huzhou, Zhejiang, China
| | - Xiaoshun Ai
- Department of Gastroenterology, Zhebei Mingzhou Hospital, 313000, Huzhou, Zhejiang, China
| | - Zijian Huang
- Department of Gastroenterology, Zhebei Mingzhou Hospital, 313000, Huzhou, Zhejiang, China
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Shay JES, Singh A. The Effect of Obesity on Gastrointestinal Disease. Gastroenterol Clin North Am 2023; 52:403-415. [PMID: 37197882 DOI: 10.1016/j.gtc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Obesity exerts both direct and indirect effects on gastrointestinal function. From physical effects of central adiposity on intragastric pressure resulting in higher incidence of reflux to dyslipidemia and effects on gallstone disease, the gastrointestinal manifestations of obesity are wide-ranging. Of particular emphasis is the identification and management of non-alcoholic fatty liver disease including non-invasive assessment and lifestyle and pharmacologic interventions for patients with non-alcoholic steatohepatitis. Additional focus is on the impact of obesity and western diet on intestinal disorders and colorectal cancer. Bariatric interventions involving the gastrointestinal tract are also discussed.
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Affiliation(s)
- Jessica E S Shay
- Massachusetts General Hospital, 55 Fruit Street, Wang Building, 5th Floor, Boston, MA 02114, USA; Koch Institute at MIT, Cambridge, MA, USA
| | - Amandeep Singh
- Massachusetts General Hospital, 55 Fruit Street, Wang Building, 5th Floor, Boston, MA 02114, USA; Harvard Medical School, 55 Fruit Street, Wang Building, 5th Floor, Boston, MA 02114, USA.
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Srivastava S, Kumar R. Is hyperleptinemia associated with gallstone disease? A systematic review and meta-analysis. Indian J Gastroenterol 2023; 42:324-331. [PMID: 37247176 DOI: 10.1007/s12664-022-01332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/18/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Obesity is one of the risk factors for gallstone disease (GD). Leptin hormone is known to regulate central obesity. Thus, hyperleptinemia may also be involved in gallstone disease pathogenesis. In the present study, a meta-analysis was performed to compare the leptin levels in GD and controls. METHODS The authors reviewed studies till April 12, 2021, which reported the serum leptin levels in gallstone patients and healthy controls. The online search involved ScienceDirect and PubMed databases. The data obtained from the research articles was scrutinized for selection criteria. Only those articles which fulfilled the inclusion criteria were subjected to meta-analysis. RESULTS Of 2047 articles, a total of eight studies met the inclusion and exclusion criteria and were considered for the meta-analysis. After meta-analysis, it was observed that the patients with GD had high leptin levels as compared to healthy controls. A significant level of heterogeneity was observed in the included studies (I2 = 89%, p < 0.01). There was no publication bias. CONCLUSION High leptin levels might be involved in GD pathogenesis.
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Affiliation(s)
| | - Ravindra Kumar
- ICMR-National Institute of Research in Tribal Health, Nagpur Road, P.O. Garha, Jabalpur, 482 003, India.
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Zhang DY, Yang S, Geng HX, Yuan YJ, Ding CJ, Yang J, Li MY. Real-time continuous image guidance for endoscopic retrograde cholangiopancreatography based on 3D/2D registration and respiratory compensation. World J Gastroenterol 2023; 29:3157-3167. [PMID: 37346159 PMCID: PMC10280790 DOI: 10.3748/wjg.v29.i20.3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND It has been confirmed that three-dimensional (3D) imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography (ERCP), which reduces the radiation dose and procedure time with improved safety. However, current 3D biliary imaging does not have good real-time fusion with intraoperative imaging, a process meant to overcome the influence of intraoperative respiratory motion and guide navigation. The present study explored the feasibility of real-time continuous image-guided ERCP. AIM To explore the feasibility of real-time continuous image-guided ERCP. METHODS We selected 2 3D-printed abdominal biliary tract models with different structures to simulate different patients. The ERCP environment was simulated for the biliary phantom experiment to create a navigation system, which was further tested in patients. In addition, based on the estimation of the patient's respiratory motion, preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP. RESULTS Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm ± 0.13 mm and a tracking error of 0.64 mm ± 0.24 mm. After estimating the respiratory motion, 3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients, with an average fusion rate of 88%. CONCLUSION Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.
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Affiliation(s)
- Da-Ya Zhang
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Yang
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Hai-Xiao Geng
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Yu-Jia Yuan
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Chi-Jiao Ding
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Jian Yang
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Ming-Yang Li
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Liu YQ, Wang C, Cai X, Zheng ZX, Bi JT. Can the parkland grading scale predict the difficulty of laparoscopic cholecystectomy? A new approach to validation. BMC Surg 2023; 23:142. [PMID: 37231385 DOI: 10.1186/s12893-023-02036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The Parkland Grading Scale (PGS) is an intraoperative grading scale to stratify gallbladder disease severity during laparoscopic cholecystectomy (LC). We evaluated the usefulness of the PGS in predicting the difficulty levels of LC procedures using a novel approach. METHODS A total of 261 patients diagnosed with cholelithiasis and cholecystitis who underwent LC were assessed. The PGS and the surgical difficulty grading system were used to evaluate surgical procedures by reviewing the operation videos. Clinical baseline characteristics and post-treatment outcomes were also recorded. Differences between the five PGS grades in terms of surgical difficulty scores were analyzed using the Jonckheere-Terpstra test. The relationship between PGS grades and surgical difficulty scores was assessed using Spearman's Rank correlation. Finally, the linear trends between morbidity scores and PGS grades were evaluated using the Mantel-Haenszel test. RESULTS There was a significant difference in the surgical difficulty scores for the five PGS grades (p < 0.001). In pairwise comparison, each grade (1-5) was significantly different from the others (p < 0.05) in terms of surgical difficulty, except Grade 2 vs. 3 (p = 0.07) and Grade 3 vs. 4 (p = 0.08). There was a significant correlation between PGS grades and surgical difficulty scores (rs = 0.681, p < 0.001). There was also a significant linear association between morbidity and PGS grades (p < 0.001). Spearman's R value was 0.176 (p = 0.004). CONCLUSION The PGS can accurately assess the surgical difficulty level of LC. The precision and conciseness of the PGS make it suitable for use in future research.
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Affiliation(s)
- Ya-Qi Liu
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Chao Wang
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xuan Cai
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Zhi-Xue Zheng
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Jing-Tao Bi
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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Haq R, Chatterton B, Gesner L. Exploring the imaging features and treatment options of Mirizzi syndrome. Radiol Case Rep 2023; 18:1890-1894. [PMID: 36936805 PMCID: PMC10020462 DOI: 10.1016/j.radcr.2023.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 03/11/2023] Open
Abstract
The patient is a 54-year-old female who presented to the emergency department for episodic right biliary colic with nausea and vomiting over the past year. The patient's symptoms warranted multiple emergency department visits, but were self-limiting. During the most recent visit, the patient had a low-grade fever of 99.8°F (96.8°F-99.5°F) and a borderline elevated total bilirubin of 1.2 (0.2-1.2 mg/dL). Abdominal ultrasound revealed cholelithiasis, gallbladder wall thickening, and biliary ductal dilatation. Subsequent MRCP revealed an impacted stone within the gallbladder neck and a prominent common hepatic duct, compatible with Mirizzi syndrome Type I. The obtained imaging combined with clinical correlation in the setting of jaundice and right upper quadrant pain guided the patient's management. A laparoscopic cholecystectomy was performed and the patient was safely discharged the following day.
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Leoni FP, Puccinelli C, Pelligra T, Gori E, Marchetti V, Diana A, Linta N, Citi S. Ultrasonographic appearance and possible clinical relevance of hyperechoic foci of mineralization in the canine intrahepatic biliary tree. Open Vet J 2023; 13:541-549. [PMID: 37304613 PMCID: PMC10257450 DOI: 10.5455/ovj.2023.v13.i5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background The evidence of mineralizations in the canine liver is usually considered an incidental finding of unclear clinical significance, frequently observed in small-size old dogs. Aim To describe the ultrasound features of intrahepatic biliary tree foci of mineralization, to assess their clinical relevance and their possible relationship with other gastrointestinal pathological disorders. Methods A retrospective analysis evaluating the database of canine patients admitted to two referral veterinary centers we carried out. All dogs under study underwent an abdominal ultrasound examination in which intrahepatic biliary tree mineralization was found. Clinical and anamnestic data of the included dogs were reviewed. Results Approximatively 90% of the patients showed ultrasonographic abnormalities regarding the biliary system, and over 85% presented ultrasonographic abnormalities of the hepatic parenchyma. In 81.2% of dogs, ultrasonographic anomalies in the digestive tract were observed. In approximately half of our patients, we evidenced increased liver enzymes (alkaline phosphatase, alanine aminotransferase, and gamma-glutamyl transferase). At the clinical evaluation, 84.4% (23 out of 32 dogs) of patients showed signs of gastrointestinal disease that persisted for over 3 months. Conclusion The presence of intrahepatic biliary tree mineralizations is an unusual and frequently incidental finding that could be related to a bile stasis condition, a chronic inflammatory disease involving the biliary system and the hepatic parenchyma, and it could be associated with a liver-gut axis alteration.
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Affiliation(s)
- Federico Puccini Leoni
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Caterina Puccinelli
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Tina Pelligra
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Eleonora Gori
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Veronica Marchetti
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Alessia Diana
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nikolina Linta
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Simonetta Citi
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Eskelinen M, Repo A, Saimanen I, Selander T, Kärkkäinen J, Juvonen P, Aspinen S, Pulkkinen J, Eskelinen M. First RAND-36-Item Health Survey in Three-dimensional Laparoscopy Cholecystectomy: A Prospective Randomized Study. In Vivo 2023; 37:1192-1197. [PMID: 37103083 DOI: 10.21873/invivo.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM National healthcare organizers require feedback from patients to improve medical treatment methods. Three-dimensional laparoscopy cholecystectomy (3D-LC) is a modern technique in surgery. However, there are no studies with patient feedback from validated questionnaires assessing the postoperative treatment results in 3D-LC. PATIENTS AND METHODS Initially 200 patients with symptomatic cholelithiasis were randomized into 3D-LC or mini-laparotomy cholecystectomy (MC) groups. RAND-36-Item Health Survey was performed preoperatively and 4 weeks following surgery relating the survey scores between the 3D-LC and MC groups. RESULTS Similar postoperative RAND-36 scores were reported for both groups preoperatively and at 4 weeks following surgery, and no significant differences in RAND-36 domains were shown. When the patients in both study groups were combined, Mental Health (p<0.001), Bodily Pain (p=0.01) and General Health (p=0.016) domain scores were significantly higher, indicating a significantly positive change in quality of life 4 weeks postoperatively, while those for the Role-Physical domain were significantly lower, indicating reduced physical activity during the 4 weeks following surgery. In comparison to the Finnish reference RAND-36 scores, scores at 4 weeks were significantly higher for the Mental Health domain (MC group, p<0.001 and 3D-LC group, p=0.001) whilst scores were significantly lower in four other domains: Physical Functioning, Social Functioning, Bodily Pain and Role-Physical. CONCLUSION This study shows, for the first time using the RAND-36-Item Health Survey, relatively similar short-term outcomes in patients 4 weeks following cholecystectomy by 3D-LC and MC. Although scores for three RAND-36 domains were significantly higher postoperatively, indicating a significantly positive change in quality of life, a longer follow-up after cholecystectomy is needed for final conclusions to be drawn.
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Affiliation(s)
- Maaret Eskelinen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Anni Repo
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Iina Saimanen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital (KUH), Finland and University of Eastern Finland (UEF), Kuopio, Finland
| | - Jari Kärkkäinen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Petri Juvonen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Samuli Aspinen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Jukka Pulkkinen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital (KUH), Kuopio, Finland;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Peck GL, Kuo YH, Nonnenmacher E, Gracias VH, Hudson SV, Roy JA, Strom BL. Ten-Year Trends of Persistent Mortality With Gallstone Disease: A Retrospective Cohort Study in New Jersey. Gastro Hep Adv 2023; 2:818-826. [PMID: 38037550 PMCID: PMC10688394 DOI: 10.1016/j.gastha.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND AIMS Recent trends in mortality with gallstone disease remain scarce in the United States. Yet multiple changes in clinical management, such as rates of endoscopy, cholecystectomy, and cholecystostomy, and insurance access at the state level, may have occurred. Thus, we evaluated recent secular trends of mortality with gallstone disease in New Jersey. METHODS We performed a retrospective, cohort study of mortality from 2009 to 2018 using the National Center for Health Statistics, Restricted Mortality Files. The primary outcome was any death with an International Classifications of Disease, 10th Revision, Clinical Modification diagnosis code of gallstone disease in New Jersey. Simple linear regression was used to model trends of incidence of death. RESULTS 1580 deaths with diagnosed gallstone disease (dGD) occurred from 2009 to 2018. The annual trend of incidence of death was flat over 10 years. The incidence of death with dGD relative to all death changed only from 0.21% to 0.20% over 10 years. These findings were consistent also in 18 of 20 subgroup combinations, although the trend of death with dGD in Latinos 65 years or older increased [slope estimate 0.93, 95% confidence limit 0.42-1.43, P = .003]. CONCLUSION The rate of death with dGD showed little change over the recent 10 years in New Jersey. This needs to be reproduced in other states and nationally. A closer examination of the changes in clinical care and insurance access is needed to help understand why they did not result in a positive change in this avoidable cause of death.
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Affiliation(s)
- Gregory L. Peck
- Division of ACS – Academic Office, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
- New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers University Clinical and Translational Science Award (CTSA) Hub for the National Center for Advancing Translational Science, New Brunswick, New Jersey
| | - Yen-Hong Kuo
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Edward Nonnenmacher
- Rutgers Institute for Health, Health Care Policy, and Aging Research, Institute for Health, New Brunswick, New Jersey
| | - Vicente H. Gracias
- Division of ACS – Academic Office, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Shawna V. Hudson
- New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers University Clinical and Translational Science Award (CTSA) Hub for the National Center for Advancing Translational Science, New Brunswick, New Jersey
- Department of Family Practice, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jason A. Roy
- New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers University Clinical and Translational Science Award (CTSA) Hub for the National Center for Advancing Translational Science, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Brian L. Strom
- Rutgers Biomedical and Health Sciences, Newark, New Jersey
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Wang S, Lu Q, Zhou Y, Zhang H. Efficacy and safety of endoscopic retrograde cholangiopancreatography in patients over 75 years of age. J Minim Access Surg 2023; 19:193-201. [PMID: 37056083 PMCID: PMC10246631 DOI: 10.4103/jmas.jmas_325_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 04/15/2023] Open
Abstract
Background To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly choledocholithiasis patients compared with younger groups. Methods This was a case-control study conducted from January 2018 to December 2020 at Fuyang People's Hospital, with 596 patients included. Patients who underwent ERCP were classified as two groups based on age stratification definitions from the National Institute of Health and the World Health Organisation: Patients <75 ages (n = 204) and patients ≥75 ages (n = 392). Demographic characteristics, details of endoscopic therapy, complications were retrospectively reviewed and compared between two groups. The subgroup was pre-formed to further explore the efficacy and safety of ERCP in the elderly population. Results Between patients ≥75 ages and patients <75 ages, there were no significant differences in the complete stone removal rate and a second ERCP. Intubation difficulty (odds rate [OR]: 1.723, 95% confidence interval [CI]: 1.118-2.657) and longer ERCP operation time (β = 4.314, 95% CI: 2.366-6.262) were observed in the elderly group at a higher frequency than the younger group. Elder patients were more likely to have intra-operative complications (χ2 = 18.158, P < 0.001), and post-operative complications (χ2 = 8.739, P = 0.003). In the subgroup group, ERCP was efficacious and safe in elderly patients with comorbidities. Conclusions ERCP may be efficaciously performed on elderly patients. However, intra-operative and post-operative complications of ECRP should also be taken into consideration when selecting therapeutic options.
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Affiliation(s)
- Shuangping Wang
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Qifeng Lu
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Yabai Zhou
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Hao Zhang
- Department of Clinical Medicine, Wannan Medical College, Wuhu, P.R. China
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Moreno Alfonso JC, Molina Caballero A, Ros Briones R, Pérez Martínez A, Bardají Pascual C. Single-port transumbilical pediatric cholecystectomy: any benefits for the patient? Cir Pediatr 2023; 36:67-72. [PMID: 37093115 DOI: 10.54847/cp.2023.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. MATERIALS AND METHODS A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. RESULTS 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs. LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, with a premium of 44.30 € owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. CONCLUSIONS In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.
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Affiliation(s)
- J C Moreno Alfonso
- Pediatric Surgery Department. Hospital Universitario de Navarra. Pamplona (Spain)
| | - A Molina Caballero
- Pediatric Surgery Department. Hospital Universitario de Navarra. Pamplona (Spain)
| | - R Ros Briones
- Pediatric Surgery Department. Hospital Universitario de Navarra. Pamplona (Spain)
| | - A Pérez Martínez
- Pediatric Surgery Department. Hospital Universitario de Navarra. Pamplona (Spain)
| | - C Bardají Pascual
- Pediatric Surgery Department. Hospital Universitario de Navarra. Pamplona (Spain)
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Burckhardt O, Peisl S, Rouiller B, Colinet E, Egger B. Length of the Remnant Cystic Duct and Bile Duct Stone Recurrence: a Case‒Control Study. J Gastrointest Surg 2023:10.1007/s11605-023-05607-x. [PMID: 36859605 DOI: 10.1007/s11605-023-05607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Since the introduction of the Critical View of Safety approach in laparoscopic cholecystectomy, exposure of the common bile duct, and common hepatic duct is not recommended, therefore, the length of the cystic duct remnant is no longer controlled. The aim of this case‒control study is to evaluate the relationship between the length of the cystic duct remnant and the risk for bile duct stone recurrence after cholecystectomy. METHODS All MRIs with dedicated sequences of the biliary tract taken between 2010 and 2020 from patients who underwent prior cholecystectomy were reviewed. The length of the cystic duct remnant was measured and compared between the patients with and without bile duct stones using multivariate logistic regression analysis. RESULTS A total of 362 patients were included in this study, 23.5% of whom had bile duct stones on MRI. The cystic duct remnant was significantly longer in the patients with stones than in the control group (median 31 mm versus 18 mm, P < 0.001). In the MRIs performed > 2 years after cholecystectomy, the cystic duct remnant was also significantly longer in the patients with bile duct stones (median 32 mm versus 21 mm, P < 0.001). A cystic duct remnant ≥ 15 mm in length increased the odds of stones (OR = 2.3, P = 0.001). Overall, the odds of bile duct stones increased with an increasing cystic duct remnant length (≥ 45 mm, OR = 5.0, P < 0.001). CONCLUSIONS An excessive cystic duct remnant length increases the odds of recurrent bile duct stones after cholecystectomy.
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Affiliation(s)
- Oliver Burckhardt
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | - Sarah Peisl
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | | | - Emilie Colinet
- Department of Radiology, HFR Fribourg - Cantonal Hospital, Villars-Sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland. .,University of Fribourg, Av. de l'Europe 20, 1700, Fribourg, Switzerland.
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Poprom N, Suragul W, Muangkaew P, Vassanasiri W, Rungsakulkij N, Mingphruedhi S, Tangtawee P. Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis patients: A systematic review and meta-analysis. Ann Hepatobiliary Pancreat Surg 2023; 27:20-27. [PMID: 36221300 PMCID: PMC9947374 DOI: 10.14701/ahbps.22-040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 02/17/2023] Open
Abstract
There are many variations and unclear definitions of the appropriate timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP), and there is still a lack of consistency about the appropriate timing. Inappropriate timing can be associated with serious comorbidity and can affect the patients. This meta-analysis was conducted to assess the operative outcomes and morbidity to provide a benefit to the patients based on the best timing of LC after ERCP. Randomized controlled trials (RCTs) and retrospective studies were identified from the PubMed and Scopus databases from inception to July 2021. A meta-analysis was performed to estimate the treatment effects on operative outcomes and morbidity. Four RCTs and four retrospective studies met our inclusion criteria. A meta-analysis indicated that patients who received LC after ERCP on the same day or within 72 hours had about 0.354 days shorter length of hospital stay with a shorter operative time of about 0.111-1.835 minutes and a lower risk of complications around 37%-73%. Our evidence suggests that the appropriate timing of LC after ERCP is either the same day or within 72 hours for treating cholelithiasis patients based on the severity of disease.
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Affiliation(s)
- Napaphat Poprom
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wikran Suragul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paramin Muangkaew
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Watoo Vassanasiri
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narongsak Rungsakulkij
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somkit Mingphruedhi
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsatorn Tangtawee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Corresponding author: Pongsatorn Tangtawee, MD Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachatevi, Bangkok 10400, Thailand Tel: +66-2-201-1527, Fax: +66-2-201-1316, E-mail: ORCID: https://orcid.org/0000-0001-9598-5479
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Pavlidis ET, Pavlidis TE. Current management of concomitant cholelithiasis and common bile duct stones. World J Gastrointest Surg 2023; 15:169-176. [PMID: 36896310 PMCID: PMC9988640 DOI: 10.4240/wjgs.v15.i2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 02/27/2023] Open
Abstract
The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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