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Liu P, Chen YW, Liu C, Wu YT, Zhao WC, Zhu JY, An Y, Xia NX. Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery. Hepatobiliary Pancreat Dis Int 2024; 23:288-292. [PMID: 36443144 DOI: 10.1016/j.hbpd.2022.11.001] [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: 01/10/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladder-preserving surgery. This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence. METHODS The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected. The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis. A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables. The C-index, receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence. RESULTS During the follow-up period, a total of 65 patients experienced gallstone recurrence, and the recurrence rate was 35.5%. Multivariate logistic regression analysis revealed that the course of gallstones > 2 years [odds ratio (OR) = 2.567, 95% confidence interval (CI): 1.270-5.187, P = 0.009], symptomatic gallstones (OR = 2.589, 95% CI: 1.059-6.329, P = 0.037), multiple gallstones (OR = 2.436, 95% CI: 1.133-5.237, P = 0.023), history of acute cholecystitis (OR = 2.778, 95% CI: 1.178-6.549, P = 0.020) and a greasy diet (OR = 2.319, 95% CI: 1.186-4.535, P = 0.014) were independent risk factors for gallstone recurrence after gallbladder-preserving surgery. A nomogram model for predicting the recurrence of gallstones was established based on the above five variables. The results showed that the C-index of the nomogram model was 0.692, suggesting it was valuable to predict gallstone recurrence. Moreover, the calibration curve showed good consistency between the predicted probability and actual probability. CONCLUSIONS The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones. Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.
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Affiliation(s)
- Peng Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Yong-Wei Chen
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Che Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Yin-Tao Wu
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Wen-Chao Zhao
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Jian-Yong Zhu
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Yang An
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China
| | - Nian-Xin Xia
- Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepetobiliary Surgery of Chinese PLA, Beijing 100853, China.
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Zhang D, Wu C, Liu Y, Li W, Li S, Peng L, Kang L, Ullah S, Gong Z, Li Z, Ding D, Jin Z, Huang H. Microplastics are detected in human gallstones and have the ability to form large cholesterol-microplastic heteroaggregates. J Hazard Mater 2024; 467:133631. [PMID: 38335610 DOI: 10.1016/j.jhazmat.2024.133631] [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] [Received: 10/12/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
Ubiquitous pollution due to microplastics through the food chain is a major cause of various deleterious effects on the human health. The aim of this study was to determine the existence of microplastics and the internal mechanism of microplastics as accelerators of cholelithiasis. Gallstones were collected from 16 patients after cholecystectomy, and microplastics in the gallstones were detected through laser direct infrared and pyrolysis gas chromatographymass spectrometry examinations. Mice model of gallstone were constructed with or without different diameters of microplastic (0.5, 5 and 50 µm). The affinity between microplastic and cholesterol or bilirubin was tested by co-culturing and qualified using molecular dynamics simulations. Finally, altered gut microbiota among the groups were identified using 16 s rRNA sequencing. The presence of microplastics in the gallstones of all the patients were confirmed. Microplastic content was significantly higher in younger chololithiasis patients (age<50 years). Mice fed a high-cholesterol diet with microplastic drinks showed more severe chololithiasis. In terms of the mechanism, microplastics showed a higher affinity for cholesterol than for bilirubin. Significant alterations in the gut microbiota have also been identified after microplastic intake in mice. Our study revealed the presence of microplastics in human gallstones, showcasing their potential to aggravate chololithiasis by forming large cholesterol-microplastic heteroaggregates and altering the gut microbiota.
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Affiliation(s)
- Deyu Zhang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Chang Wu
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yue Liu
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Wanshun Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Shiyu Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Lisi Peng
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Le Kang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Saif Ullah
- Department of Gastroenterology, First affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Zijun Gong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Dan Ding
- Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Haojie Huang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
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Aitha S, Sasmal PK, Kumar P, Challawar R, Sinha M. Chronic abdominal wall sinus secondary to missed spilled gallstones in laparoscopic cholecystectomy: a harrowing experience. J Minim Invasive Surg 2024; 27:51-54. [PMID: 38494188 PMCID: PMC10961229 DOI: 10.7602/jmis.2024.27.1.51] [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] [Received: 04/06/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 03/19/2024]
Abstract
Gallbladder perforation with spillage of gallstones is not uncommon during laparoscopic cholecystectomy. Stone spillage can cause several complications. We report a case of recurrent discharging sinuses on the right back 4 years after laparoscopic cholecystectomy in a 44-year-old female patients. She suffered for 9 years to undergo empirical treatment for suspected tuberculosis, including repeated attempts at sinus tract excision done at different hospitals. We did a computed tomography sinogram, which revealed the tract extending from the right flank into a cavity in the right subpleural space. We proceeded with the sinus tract excision which extended between the tips of the 10th and 11th ribs, spreading to the right subpleural space where pus mixed with multiple gall stones were retrieved. Spilled stones may result in complications, making diagnosis difficult and seriously harming the patient physically, mentally, and economically. The need for accurate documentation and patient knowledge of missing gallstones cannot be understated.
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Affiliation(s)
- Saikrishna Aitha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prakash Kumar Sasmal
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pankaj Kumar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Rutuja Challawar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Medhavi Sinha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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Zhu JH, Zhao SL, Kang Q, Zhu Y, Liu LX, Zou H. Classification of anatomical morphology of cystic duct and its association with gallstone. World J Gastrointest Surg 2024; 16:307-317. [PMID: 38463380 PMCID: PMC10921219 DOI: 10.4240/wjgs.v16.i2.307] [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: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored. AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones. METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis. RESULTS Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones. CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
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Affiliation(s)
- Jia-Hai Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Song-Ling Zhao
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Qiang Kang
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Ya Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Li-Xin Liu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming 650106, Yunnan Province, China
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Lin YC, Chen IC, Chen YJ, Lin CT, Chang JC, Wang TJ, Chen YM, Lin CH. Association between HNF4A rs1800961 polymorphisms and gallstones in a Taiwanese population. J Gastroenterol Hepatol 2024; 39:305-311. [PMID: 38058101 DOI: 10.1111/jgh.16426] [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: 03/26/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM A large genetic effect of a novel gallstone-associated genetic variant, the hepatocyte nuclear factor 4α (HNF4A) rs1800961 polymorphism, has been identified through recent genome-wide association studies. However, this effect has not been validated in Asian populations. We investigated the association between the rs1800961 variant and gallstones among a Taiwanese population. METHODS A total of 20 405 participants aged between 30 and 70 years voluntarily enrolled in the Taiwan Biobank. Self-report questionnaires, physical examinations, biochemical tests, and genotyping were used for analysis. The association of the HNF4A rs1800961 variant and other metabolic risks with gallstone disease was analyzed using multiple logistic regression models. RESULTS The minor T allele of HNF4A rs1800961 was associated with an increased risk of gallstone, and the association remained significant even after adjustment for other risk factors including age, body mass index (BMI), diabetes, hyperlipidemia, hypertension, and cigarette smoking (adjusted odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.31 to 2.75) in male participants. When further stratified by BMI and age, the lithogenic effect was the most significant in male participants with obesity (adjusted OR = 3.55, 95% CI = 1.92 to 6.56) and who were younger (adjusted OR = 2.45, 95% CI = 1.49 to 4.04). CONCLUSION The novel gallstone-associated HNF4A rs1800961 variant was associated with the risk of gallstone in the Taiwanese men. Screening for the rs1800961 polymorphism may be particularly useful in assessing the risk of gallstone formation in younger or obese men.
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Affiliation(s)
- Ying-Cheng Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Ju Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui-Chun Chang
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Jung Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Precision Medicine Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Murabayashi T, Nakamura H, Sugimoto S. Migration of a Common Bile Duct Stone into the Main Pancreatic Duct due to Catheter Manipulation during Endoscopic Retrograde Cholangiopancreatography. Case Rep Gastroenterol 2024; 18:161-166. [PMID: 38532800 PMCID: PMC10965233 DOI: 10.1159/000538009] [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: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction We report the first case of a choledocholithiasis migrating into the main pancreatic duct (MPD) due to catheter manipulation during endoscopic retrograde cholangiopancreatography (ERCP). Case Presentation A 57-year-old woman complaining of vomiting was diagnosed with acute cholangitis and pancreatitis due to choledocholithiasis. During ERCP, the stone migrated from the papilla into the MPD due to the pushing motion of the catheter. However, the ERCP session was completed after biliary sphincterotomy without intervention in the MPD because the migration was not noticed. The migrated stone became apparent on computed tomography the following day. The second ERCP revealed the stone measuring 5 mm in the MPD. After pancreatic sphincterotomy, a pancreatic stent was placed, which improved the obstructive pancreatitis. Conclusion Endoscopists performing ERCP should be aware of this rare but serious complication.
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Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Haruka Nakamura
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
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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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Amri F, Belkhayat C, Chahi K, Aggari HE, Zazour A, Koulali H, Mqaddem OEL, Skiker I, Kharrasse G, Ismaili Z. Upper gastrointestinal bleeding revealing a Bouveret syndrome: A case report. Radiol Case Rep 2023; 18:4549-4552. [PMID: 37868004 PMCID: PMC10587669 DOI: 10.1016/j.radcr.2023.09.052] [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: 08/15/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.
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Affiliation(s)
- Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Chifaa Belkhayat
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Kaoutar Chahi
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hanane El Aggari
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ouiam EL Mqaddem
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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Uwatoko R, Kani N, Makino S, Naka T, Okamoto K, Miyakawa H, Hashimoto N, Iio R, Ueda Y, Hayashi T. Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome with recurrent acute cholecystitis: a case report. CEN Case Rep 2023:10.1007/s13730-023-00831-5. [PMID: 37962818 DOI: 10.1007/s13730-023-00831-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) can induce life-threatening complications, including acute kidney injury, encephalopathy, and gastrointestinal complications. On the other hand, there have been few reports of cholecystitis associated with STEC-HUS. In this study, we report the case of an 83-year-old Japanese man who developed recurrent acute cholecystitis associated with STEC-HUS. Prior to establishing a definite diagnosis of STEC-HUS, plasma exchange and hemodialysis were initiated, which resulted in a rapid increase in the platelet count and decrease in lactate dehydrogenase levels. The patient presented an enlarged gallbladder detected by computed tomography during the course of treatment. Due to recurrent flare-ups, the patient had to undergo several rounds of endoscopic retrograde biliary drainage and, ultimately, cholecystectomy to prevent relapse of acute cholecystitis. Since cholecystitis was thought to have been caused by complex mechanisms in this case, we discussed those from multiple perspectives. This case report highlights the need for particular care to be given to the management of pre-existing diseases as well as STEC-HUS, especially in older patients.
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Affiliation(s)
- Ryuta Uwatoko
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | - Nao Kani
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Shuzo Makino
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tomoya Naka
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kazuhiro Okamoto
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Hiromitsu Miyakawa
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Nobuhiro Hashimoto
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Rei Iio
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yoshiyasu Ueda
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
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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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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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12
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Shen S, Huang D, Qian S, Ye X, Zhuang Q, Wan X, Dong Z. Hyodeoxycholic acid attenuates cholesterol gallstone formation via modulation of bile acid metabolism and gut microbiota. Eur J Pharmacol 2023; 955:175891. [PMID: 37429516 DOI: 10.1016/j.ejphar.2023.175891] [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: 01/31/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND & AIMS Hyodeoxycholic acid (HDCA), a hydrophilic bile acid (BA), may prevent and suppress the formation of cholesterol gallstones (CGs). However, the mechanism by which HDCA prevents CGs formation remains unclear. This study aimed to investigate the underlying mechanism of HDCA in preventing CG formation. METHODS C57BL/6J mice were fed either a lithogenic diet (LD), a chow diet, or LD combined with HDCA. The concentration of BAs in the liver and ileum were determined using liquid chromatography-mass spectrometry (LC-MS/MS). Genes involved in cholesterol and BAs metabolism were detected using polymerase chain reaction (PCR). The gut microbiota in the faeces was determined using 16S rRNA. RESULTS HDCA supplementation effectively prevented LD-induced CG formation. HDCA increased the gene expression of BA synthesis enzymes, including Cyp7a1, Cyp7b1, and Cyp8b1, and decreased the expression of the cholesterol transporter Abcg5/g8 gene in the liver. HDCA inhibited LD-induced Nuclear farnesoid X receptor (Fxr) activation and reduced the gene expression of Fgf15 and Shp in the ileum. These data indicate that HDCA could prevent CGs formation partly by promoting BA synthesis in the liver and reduced the cholesterol efflux. In addition, HDCA administration reversed the LD-induced decrease in the abundance of norank_f_Muribaculaceae, which was inversely proportional to cholesterol levels. CONCLUSIONS HDCA attenuated CG formation by modulating BA synthesis and gut microbiota. This study provides new insights into the mechanism by which HDCA prevents CG formation. LAY SUMMARY In this study, we found that HDCA supplementation suppressed LD-induced CGs in mice by inhibiting Fxr in the ileum, enhancing BA synthesis, and increasing the abundance of norank_f_Muribaculaceae in the gut microbiota. HDCA can also downregulate the level of total cholesterol in the serum, liver, and bile.
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Affiliation(s)
- Shuang Shen
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Central Lab, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Huang
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengnan Qian
- Central Lab, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ye
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zhuang
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinjian Wan
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhixia Dong
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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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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Li G, Yu T, Du H, Zhang L, Liu X, Hou S. Effect of Clostridium butyricum on the formation of primary choledocholithiasis based on intestinal microbiome and metabolome analysis. J Appl Microbiol 2023; 134:lxad170. [PMID: 37533214 DOI: 10.1093/jambio/lxad170] [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: 02/06/2023] [Revised: 07/11/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Abstract
AIMS To investigate the function and probable mechanism of Clostridium butyricum in the development of choledocholithiasis. METHODS AND RESULTS The lithogenic diet group and the lithogenic diet + C. butyricum group were used to develop the choledocholithiasis model. During the experiment, C. butyricum suspension was administered to the rats in the lithogenic diet + C. butyricum group. The findings demonstrated that the C. butyricum intervention decreased the Firmicutes/Bacteroidetes ratio in the colon of experimental animals given a lithogenic diet. The relative levels of Desulfovibrio (0.93%) and Streptococcus (0.38%) fell, whereas Lactobacillus (22.36%), Prevotella (14.09%), and bacteria that produce short-chain fatty acids increased. Finally, 68 distinct metabolic products were found based on nontargeted metabonomics, and 42 metabolic pathways associated to the various metabolites were enriched. CONCLUSIONS We found that C. butyricum decreased the development of choledocholithiasis. It keeps the equilibrium of the rat's gut microbiome intact and lowers the danger of bacterial infections of the gastrointestinal and biliary systems. It is hypothesized that by controlling lipid metabolism, it may also have an impact on the development of cholelithiasis.
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Affiliation(s)
- Guofu Li
- Biliopancreatic Endoscopic Surgery Department, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
| | - Tingting Yu
- Biliopancreatic Endoscopic Surgery Department, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
| | - Haiming Du
- Biliopancreatic Endoscopic Surgery Department, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
| | - Lichao Zhang
- Biliopancreatic Endoscopic Surgery Department, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
| | - Xiaoxuan Liu
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
| | - Senlin Hou
- Biliopancreatic Endoscopic Surgery Department, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, P. R. China
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Shi C, Liu X, Xie Z, Sun H, Hao C, Xue D, Meng X. Lifestyle factors and the risk of gallstones: results from the national health and nutrition examination survey 2018-2020 and mendelian randomization analysis. Scand J Gastroenterol 2023; 58:1021-1029. [PMID: 37021459 DOI: 10.1080/00365521.2023.2197093] [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: 02/22/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES This study aimed to investigate the relationship between lifestyle and gallstones. MATERIALS AND METHODS We performed an observational study using the 2018-2020 National Health and Nutrition Examination Survey (NHANES). Univariate and multivariate-adjusted logistic regression analyses were performed to assess the correlations between lifestyle factors and gallstone risk. Second, Mendelian randomization (MR) was applied to decrease the causal relationship between lifestyle factors and gallstones. RESULTS This observational study enrolled 11,970 individuals. The risk of gallstones was found to increase with increased sitting time (odds ratio (OR) 1.03, 95% CI 1.00-1.05, p = 0.02). In contrast, the risk of gallstones was found to decrease with recreational activity (OR 0.50, 95% CI 0.29-0.87, p = 0.02). The results of the MR also showed that time spent watching television (OR 1.646; 95% CI 1.161-2.333, p = 0.005) and physical activity (OR 0.953, 95% CI 0.924-0.988, p = 0.003) remained independently causally associated with gallstones. CONCLUSIONS Prolonged sitting increases the risk of gallstones, whereas recreational activity reduces the risk. These findings need to be verified in further prospective cohort studies with larger sample sizes and longer follow-up periods.
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Affiliation(s)
- Chao Shi
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuxu Liu
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhihong Xie
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haijun Sun
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chenjun Hao
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongbo Xue
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianzhi Meng
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 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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Shen W, Shao W, Wang Q, Wang B, Zhao G, Gu A, Jiang Z, Hu H. Dietary diosgenin transcriptionally down-regulated intestinal NPC1L1 expression to prevent cholesterol gallstone formation in mice. J Biomed Sci 2023; 30:44. [PMID: 37370162 DOI: 10.1186/s12929-023-00933-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Cholesterol gallstone disease is a common disease. Reducing cholesterol burden is important to prevent/treat gallstone. In this study, we investigated the application of diosgenin (DG) to prevent the formation of gallstone in mice. METHODS Adult male C57BL/6J mice were fed with the lithogenic diet (LD) only or LD supplemented with DG or ezetimibe for 8 weeks. Incidences of gallstone formation were documented. Intestine and liver tissues were collected to measure the lipid contents and expression of genes in cholesterol metabolism. Caco2 cells were treated with DG to monitor the regulation on cholesterol absorption and the transcriptional regulation of Npc1l1 gene. Changes of gut microbiota by DG was analyzed. Intraperitoneal injection of LPS on mice was performed to verify its effects on STAT3 activation and Npc1l1 expression in the small intestine. RESULTS LD led to 100% formation of gallstones in mice. In comparison, dietary DG or ezetimibe supplementary completely prevents gallstones formation. DG inhibited intestinal cholesterol absorption in mice as well as in Caco2 cells by down-regulation of Npc1l1 expression. DG could directly inhibit phosphorylation of STAT3 and its transcriptional regulation of Npc1l1 expression. Furthermore, DG could modulate gut microbiota profiles and LPS mediated STAT3 activation and Npc1l1 expression. CONCLUSION Our results demonstrated that dietary DG could inhibit intestinal cholesterol absorption through decreasing NPC1L1 expression to prevent cholesterol gallstone formation.
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Affiliation(s)
- Weiyi Shen
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Wentao Shao
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Center for Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qihan Wang
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Bo Wang
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Gang Zhao
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Aihua Gu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Center for Global Health, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Zhaoyan Jiang
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China.
| | - Hai Hu
- Center of Gallstone Disease, Shanghai East Hospital, and Institution of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China.
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Mohamed MFH, Elfert K, Wadhavkar N, Marino D, Farrakhan K, Beran A, Abdallah MA, Abdalla A, Farrell R. Choledocholithiasis Can Present with Marked Transaminases Elevation: Systematic Review and Meta-Analysis. Dig Dis Sci 2023:10.1007/s10620-023-07981-7. [PMID: 37269372 DOI: 10.1007/s10620-023-07981-7] [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: 01/07/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Extreme transaminase elevation > 1000 international units per liter (IU/L) is typically caused by hepatocellular injury due to ischemia, drugs, or viral infection. Acute choledocholithiasis can also present with marked transaminase elevation mimicking severe hepatocellular injury, contrary to the presumed cholestatic pattern. METHODS We searched PubMed/Medline, EMBASE, Cochrane Library, and Google Scholar for studies reporting the proportion of marked elevation of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 1000 IU/L in patients with common bile duct (CBD) stones. A proportion meta-analysis with a corresponding 95% confidence interval (CI) was used to pool the proportion of patients with extreme transaminase elevation. I2 was used to examine heterogeneity. We used CMA software utilizing a random effect model for statistical analysis. RESULTS Three studies (n = 1328 patients) were included in our analysis. The reported frequency of ALT or AST > 1000 IU/L in choledocholithiasis patients ranged between 6 and 9.6%, with pooled frequency of 7.8% (95% CI 5.5-10.8%, I2 61%). The frequency of patients with ALT or AST > 500 IU/L was higher, ranging between 28 and 47%, with pooled frequency of 33.1% (95% CI 25.3-42%, I2 88%). CONCLUSION This is the first meta-analysis to study prevalence of severe hepatocellular injury in patients with CBD stones. Results revealed that approximately one-third of patients with choledocholithiasis present with ALT or AST > 500 IU/L. Furthermore, levels > 1000 IU/L are not uncommon. An elaborate work-up for alternative etiologies of severe transaminase elevation is likely unwarranted in cases with clear evidence of choledocholithiasis.
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Affiliation(s)
- Mouhand F H Mohamed
- Division of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Khaled Elfert
- Department of Medicine, SBH Health System, New York, NY, USA
| | - Neha Wadhavkar
- Division of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Daniel Marino
- Division of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Kanhai Farrakhan
- Division of Gastroenterology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Azizullah Beran
- Gastroenterology and Hepatology Department, Indiana University, Indianapolis, IN, USA
| | - Mohamed A Abdallah
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA
| | - Abubaker Abdalla
- Division of Digestive Disease, Emory University, Atlanta, GA, USA
| | - Ronan Farrell
- Division of Gastroenterology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Var I, AlMatar M, Heshmati B, Albarri O. Bacteriophage Cocktail Can Effectively Control Salmonella Biofilm on Gallstone and Tooth Surfaces. Curr Drug Targets 2023:CDT-EPUB-131934. [PMID: 37211854 DOI: 10.2174/1389450124666230519121940] [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: 11/22/2022] [Revised: 03/04/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023]
Abstract
Salmonellosis, which is typically distinguished by an immediate onset of fever, abdominal pain, diarrhea, nausea, and vomiting, is a bacterial infection caused by Salmonella. The rising incidence of antibiotic resistance in Salmonella Typhimurium is a major worldwide problem, and a better knowledge of the distribution of antibiotic resistance patterns in Salmonella Typhimurium is critical for selecting the best antibiotic for infection treatment. In this work, the efficiency of bacteriophage therapy of vegetative cells and biofilms of S. Typhimurium was investigated. Based on their host ranges, five Bacteriophages were chosen for therapy against 22 Salmonella isolates collected from various sources. PSCs1, PSDs1, PSCs2, PSSr1, and PSMc1 phages were found to exhibit potent anti-S. Typhimurium properties. In a 96-well microplate, the efficacy of bacteriophage therapy (105-1011 PFU/mL) against S. Typhimurium biofilm formers was first tested. A bacteriophage treatment (109 PFU/mL) was subsequently applied in the laboratory for 24 hours to minimize Salmonella adhering to the surfaces of gallstones and teeth. In 96-well microplate experiments, bacteriophage treatment inhibited biofilm development and reduced biofilm by up to 63.6% (P ≤ 0.05). When compared to controls, bacteriophages (PSCs1, PSDs1, PSCs2, PSSr1, PSMc1) demonstrated a rapid drop in the populations of S. Typhimurium biofilms generated on the surfaces of gallstones and teeth where the structure of the Salmonella bacteria in the biofilm was broken and holes were created. Clearly, this study indicated that phages might be employed to eliminate S. Typhimurium biofilms on gallstone and tooth surfaces.
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Affiliation(s)
- Işil Var
- Department of Food Engineering, Agricultural Faculty, Çukurova University, Adana, Turkey
| | - Manaf AlMatar
- Faculty of Education and Arts, Sohar University, Sohar, 311, Sultanate of Oman
| | - Behzad Heshmati
- Department of Food Engineering, Agricultural Faculty, Çukurova University, Adana, Turkey
| | - Osman Albarri
- Department of Biotechnology, Institute of Natural and Applied Sciences (Fen Bilimleri Enstitüsü) Çukurova University, Adana, Turkey
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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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Cikim G, Hatipoglu HS, Susam S. Evaluation of homocysteine, vitamin, and trace element levels in women with gallstones. J Trace Elem Med Biol 2023; 78:127177. [PMID: 37084687 DOI: 10.1016/j.jtemb.2023.127177] [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: 11/30/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE It was aimed to examine the changes in homocysteine, folic acid, and vitamin B12, which metabolize homocysteine from the body, and trace elements (zinc, copper, selenium, nickel) that affect the structure of tissues and epithelium in female patients with gallstone disease. Moreover, it was aimed to investigate the contribution of these selected parameters to the etiology of the disease and their usability in treatment according to the findings obtained. MATERIALS AND METHODS Eighty patients, including 40 female patients (Group I) and 40 completely healthy female individuals (Group II) were included in this study. Serum homocysteine, vitamin B12, folate, zinc, copper, selenium, and nickel levels were evaluated. Electrochemiluminescence immunoassay was used in the analysis of vitamin B12, folic acid, and homocysteine levels, and the ICP-MS method was used in the analysis of trace element levels. RESULTS Homocysteine levels in Group I were statistically significantly higher than in Group II. In terms of vitamin B12, zinc, and selenium, Group I levels were found to be statistically significantly lower than group II. There was no statistically significant difference between Group I levels and Group II in terms of copper, nickel, and folate. CONCLUSION It was suggested that homocysteine, vitamin B12, zinc, and selenium levels should be determined in patients with gallstone disease and that vitamin B12, which is especially important in the excretion of homocysteine from the body, and zinc and selenium, which prevent the free radical formation and protect from its effects, should be added to the diets of these patients.
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Affiliation(s)
- Gurkan Cikim
- Department of Biochemistry, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Hamit Sinan Hatipoglu
- Department of Surgical Medical Sciences, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Solmaz Susam
- Department of Biochemistry, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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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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Dan WY, Yang YS, Peng LH, Sun G, Wang ZK. Gastrointestinal microbiome and cholelithiasis: Current status and perspectives. World J Gastroenterol 2023; 29:1589-1601. [PMID: 36970590 PMCID: PMC10037248 DOI: 10.3748/wjg.v29.i10.1589] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/23/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
Cholelithiasis is a common digestive disease affecting 10% to 15% of adults. It imposes significant global health and financial burdens. However, the pathogenesis of cholelithiasis involves several factors and is incompletely elucidated. In addition to genetic predisposition and hepatic hypersecretion, the pathogenesis of cholelithiasis might involve the gastrointestinal (GI) microbiome, consisting of microorganisms and their metabolites. High-throughput sequencing studies have elucidated the role of bile, gallstones, and the fecal microbiome in cholelithiasis, associating microbiota dysbiosis with gallstone formation. The GI microbiome may drive cholelithogenesis by regulating bile acid metabolism and related signaling pathways. This review examines the literature implicating the GI microbiome in cholelithiasis, specifically gallbladder stones, choledocholithiasis, and asymptomatic gallstones. We also discuss alterations of the GI microbiome and its influence on cholelithogenesis.
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Affiliation(s)
- Wan-Yue Dan
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School, Nankai University, Tianjin 300071, China
| | - Yun-Sheng Yang
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Hua Peng
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Gang Sun
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zi-Kai Wang
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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24
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Dan WY, Yang YS, Peng LH, Sun G, Wang ZK. Gastrointestinal microbiome and cholelithiasis: Current status and perspectives. World J Gastroenterol 2023; 29:1445-1457. [DOI: 10.3748/wjg.v29.i10.1445] [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] [Indexed: 03/10/2023] Open
Abstract
Cholelithiasis is a common digestive disease affecting 10% to 15% of adults. It imposes significant global health and financial burdens. However, the pathogenesis of cholelithiasis involves several factors and is incompletely elucidated. In addition to genetic predisposition and hepatic hypersecretion, the pathogenesis of cholelithiasis might involve the gastrointestinal (GI) microbiome, consisting of microorganisms and their metabolites. High-throughput sequencing studies have elucidated the role of bile, gallstones, and the fecal microbiome in cholelithiasis, associating microbiota dysbiosis with gallstone formation. The GI microbiome may drive cholelithogenesis by regulating bile acid metabolism and related signaling pathways. This review examines the literature implicating the GI microbiome in cholelithiasis, specifically gallbladder stones, choledocholithiasis, and asymptomatic gallstones. We also discuss alterations of the GI microbiome and its influence on cholelithogenesis.
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Affiliation(s)
- Wan-Yue Dan
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China,Medical School, Nankai University, Tianjin 300071, China
| | - Yun-Sheng Yang
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Hua Peng
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Gang Sun
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zi-Kai Wang
- Microbiota Division, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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25
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Kim MS, Park DG, Yoon JH. Unpredictable motor fluctuations caused by cholecystitis in Parkinson's disease. Acta Neurol Belg 2023; 123:313-4. [PMID: 35150439 DOI: 10.1007/s13760-022-01896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/06/2022] [Indexed: 11/01/2022]
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26
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Chang Y, Lin HM, Chi KY, Lin WY, Chou TC. Association between statin use and risk of gallstone disease and cholecystectomy: a meta-analysis of 590,086 patients. PeerJ 2023; 11:e15149. [PMID: 37051411 PMCID: PMC10084820 DOI: 10.7717/peerj.15149] [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] [Received: 11/04/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Background Statins have been reported to reduce the risk of gallstone disease. However, the impacts of different durations of statin use on gallstone disease have not been clarified. The aim of this study is toperform a systematic review with meta-analysis to update and to elucidate the association between statin use and the risk of gallstone disease and cholecystectomy. Methods Medline, Embase and Cochrane Library were searched from the inception until August 2022 for relevant articles investigating the difference in the risk of gallstone disease between statin users and non-users (PROSPERO, ID: CRD42020182445). Meta-analyses were conducted using odds ratios (ORs) with corresponding 95% confidence intervals (CIs) to compare the risk of gallstone disease and cholecystectomy between statin user and nonusers. Results Eight studies enrolling 590,086 patients were included. Overall, the use of statins was associated with a marginally significant lower risk of gallstone disease than nonusers (OR, 0.91; 95% CI [0.82-1.00]). Further subgroup analysis showed that short-term users, medium-term users, and long-term users were associated with a significantly higher risk (OR, 1.18; 95% CI [1.11-1.25]), comparable risk (OR, 0.93; 95% CI [0.83-1.04]), and significantly lower risk of gallstone diseases (OR, 0.78; 95% CI [0.68-0.90]) respectively, compared to nonusers. Conclusions Patients with medium-term or long-term use of statins without discontinuation are at a lower risk of gallstone disease or cholecystectomy.
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Affiliation(s)
- Yu Chang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hong-Min Lin
- Department of Family Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuan-Yu Chi
- Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wan-Ying Lin
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsung-Ching Chou
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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27
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Tokur O, Aydın S, Kantarci M. Commentary on “ Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report’’. World J Clin Cases 2022; 10:12059-12061. [PMID: 36405298 PMCID: PMC9669843 DOI: 10.12998/wjcc.v10.i32.12059] [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: 09/11/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022] Open
Abstract
The present letter to the editor is related to the study titled “Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report’’. Although gallstones are relatively common diseases, its association with thromboembolism is not fully understood. We aim to emphasize the potential mechanism of this relationship in this letter. In addition, we wanted to contribute to the causes of the spleen infarction and celiac trunk pathologies.
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Affiliation(s)
- Oguzhan Tokur
- Department of Radiology, Ankara Training and Research Hospital, Ankara 06230, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University Medicine Faculty, Erzincan 24100, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University Medicine Faculty, Erzincan 24100, Turkey
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28
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Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG. Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis. World J Clin Cases 2022; 10:10399-10412. [PMID: 36312509 PMCID: PMC9602237 DOI: 10.12998/wjcc.v10.i29.10399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/17/2022] [Revised: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
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Affiliation(s)
- Brian Juin Hsien Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore S308232, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
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29
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Chuah JS, Tan JH, Khairudin KB, Ling LLL, Nur T, Mat ABT. Case series of gallstone ileus with one- or two-stage surgery. Ann Hepatobiliary Pancreat Surg 2022; 26:199-203. [PMID: 35272270 PMCID: PMC9136425 DOI: 10.14701/ahbps.21-139] [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: 10/12/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022] Open
Abstract
Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.
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Affiliation(s)
- Jun Sen Chuah
- Department of General Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia,Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia,Corresponding author: Jun Sen Chuah Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia Tel: +60-167727965, Fax: +60-72257000, E-mail: ORCID: https://orcid.org/0000-0002-1439-8027
| | - Jih Huei Tan
- Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Kharlina Binti Khairudin
- Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Louis Leong Liung Ling
- Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Tuan Nur
- Department of General Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Azmah Binti Tuan Mat
- Department of General Surgery, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
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Glick JE, Sonnenberg EM. Gallstone Ileus: A Rare Cause of Small Bowel Obstruction. J Emerg Med 2022; 62:e93-e94. [PMID: 35105468 DOI: 10.1016/j.jemermed.2021.12.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/09/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Joshua E Glick
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Ahn HS, Kim HJ, Kang TU, Park SM. Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinoma. J Gastroenterol Hepatol 2022; 37:669-677. [PMID: 34907591 DOI: 10.1111/jgh.15759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 08/13/2021] [Revised: 11/08/2021] [Accepted: 12/05/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Gallstones have been reported to be positively associated with hepatobiliary cancers. However, risks of these cancers by cholecystectomy or in patients with complicated gallstones are controversial. We studied the effect of cholecystectomy on the risk of cholangiocarcinoma (CCA) or hepatocellular carcinoma (HCC) in patients with gallstones and subgroup of complicated gallstones. METHODS Patients with gallstone disease (n = 958 677) and age-matched and sex-matched controls (n = 9 586 770) were identified using the Korean National Health Insurance database. Complicated gallstones were defined as gallstones associated with acute cholecystitis or acute cholangitis. Adjusted hazard ratios (adjusted hazard ratios, 95% confidence interval) of CCA and HCC incidences were evaluated in patients with gallstones who received cholecystectomy compared to the controls. We also analyzed these effects in patients with complicated gallstones. RESULTS Patients with gallstones showed increased risks of CCA (1.80, 1.67-1.93) and HCC (1.03, 1.00-1.07) compared with controls. Cholecystectomy had minimal effects on the risks of CCA (1.94, 1.76-2.14) and HCC (0.93, 0.87-0.99) compared with those without cholecystectomy. However, patients with complicated gallstones showed highly increased CCA risk (5.62, 4.89-6.46) and a 30% risk reduction after cholecystectomy (3.91, 3.43-4.46). Risk reduction by cholecystectomy was greater for extrahepatic CCA than for intrahepatic CCA or ampulla of Vater cancer. However, the risk of HCC was not different in patients with complicated gallstones and those who underwent cholecystectomy compared to controls. CONCLUSION The risk of CCA was markedly increased in patients with complicated gallstones and was partially reduced by cholecystectomy. The risk change of HCC was minimal with gallstones or cholecystectomy.
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Affiliation(s)
- Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Tae Uk Kang
- Health and Wellness College, Sungshin Women's University, Seoul, South Korea
| | - Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
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Abstract
BACKGROUND Gallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous components. Due to its rarity, the literature with regards to the topic is scarce and currently lacking, spanning less than 100 cases.
AIM To summarize the current literature on gallbladder carcinosarcoma.
METHODS A literature review was performed on the PubMed database using the keywords “Gallbladder” AND “Carcinosarcoma” from 1970 to 2021. Additionally, similar searches were performed on MEDLINE and Web of Science.
RESULTS Risk factors noted include female gender, gallstones and chronic cholecystitis. In the absence of any diagnostic biochemical testing or tumor markers, imaging modality serves as the key initial impression tool, which can be histologically confirmed only post-resection. While surgery is the only curative option, the use of adjunctive chemotherapy has been considered on top of excision in recent years, with some success.
CONCLUSION While this study has taken steps to bridge the gap in the literature, more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Branden Qi Yu Chua
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Li W, Liang J, Shao W, Xu C, Xu J, Jiang Z, Gu A. Maternal smoking during pregnancy is risk factor for gallbladder disease in offspring during adulthood: a prospective study from UK Biobank. Ann Hepatol 2021; 26:100558. [PMID: 34653688 DOI: 10.1016/j.aohep.2021.100558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/05/2021] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Gallbladder disease is a common disease with high prevalence. Majority of gallbladder disease is due to gallstone. Though genetics are believed to play a role in its pathogenesis, the contribution of environmental pressures in early life to the development of this disease in adulthood has not been ever investigated. This study aimed to clarify the risk of maternal smoking exposure in association with gallbladder disease in adulthood. The interaction of maternal smoking and own smoking during adulthood on this association was studied as well. PATIENTS AND METHODS A total of 286,731 eligible participants from the UK Biobank population-based cohort were included. Multivariable Cox regression analysis were used to examine the HR and 95% CI with adjustment for covariates. RESULT During a median of 8.8 years follow-up, 7110 incident cases of gallbladder disease including 6800 (95.6%) gallstone were identified. Maternal smoking was associated with increased risk of incident total gallbladder disease (HR = 1.13; 95%CI: 1.06 - 1.21; P = 0.0002) as well as gallstones (HR = 1.13; 95%CI: 1.06 -1.21; P = 0.0003) in adulthood. Compared with those who were neither exposed to maternal smoking nor own smoking, subjects adherence to no smoking during adulthood but having maternal smoking exposure still had increased risk of total gallbladder disease (HR = 1.21; 95%CI: 1.1-1.34, P=0.0001) and gallstones (HR = 1.21; 95%CI: 1.1-1.35, P=0.0001). CONCLUSION The present study using large prospective cohort data from UK Biobank, for the first time, demonstrated maternal smoking exposure bringing elevated risk of incident total gallbladder disease/gallstone in adulthood.
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Affiliation(s)
- Wenxiang Li
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jingjia Liang
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wentao Shao
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, Tongji University School of Medicine, Shanghai, China
| | - Cheng Xu
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Maternal, Child, and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jin Xu
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhaoyan Jiang
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, Tongji University School of Medicine, Shanghai, China.
| | - Aihua Gu
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
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García-Quijada García J, Valle Rubio A, Pastor Riquelme P, Serantes Gómez A. Case report: Closed-loop bowel obstruction secondary to a double gallstone ileus. Int J Surg Case Rep 2021; 89:106612. [PMID: 34823163 PMCID: PMC8627953 DOI: 10.1016/j.ijscr.2021.106612] [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: 09/26/2021] [Revised: 10/30/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance In this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications. Presentation of case The patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status. Clinical discussion Gallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management. Conclusion This pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms. Gallstone ileus is an uncommon condition which requires an emergency surgical approach. The entire intestine should be inspected during surgery. A prompt diagnosis can be achieved via CT-scan. Management of gallbladder and biliary-enteric fistula is controversial. Enterolithotomy is the procedure of choice for relieving intestinal obstruction.
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Affiliation(s)
| | - Ainhoa Valle Rubio
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Pablo Pastor Riquelme
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Ana Serantes Gómez
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
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Zhang HY, Xu YN, Zhao JG. Gallbladder perforation presenting as right upper quadrant abdominal abscess: A case report. Asian J Surg 2021:S1015-9584(21)00676-X. [PMID: 34815149 DOI: 10.1016/j.asjsur.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
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Tran A, Hoff C, Polireddy K, Neymotin A, Maddu K. Beyond acute cholecystitis- gallstone-related complications and what the emergency radiologist should know. Emerg Radiol 2021; 29:173-186. [PMID: 34787758 DOI: 10.1007/s10140-021-01999-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
The purpose of this study is to emphasize the imaging features of complications of gallstones beyond the cystic duct on ultrasound (US), enhanced and nonenhanced computed tomography (CECT and NECT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). This article includes a brief overview of gallstone imaging and emerging trends in the detection of gallstones. This review article will highlight complications of gallstones, including choledocholithiasis, gallstone pancreatitis, acute cholangitis, Mirizzi syndrome, cholecystobiliary and cholecystoenteric fistulas, and gallstone ileus. Imaging findings and limitations of US, CT, MRI, and ERCP will be discussed. The review article will also briefly discuss the management of each disease. The presence of gallstones beyond the level of the cystic duct can lead to a spectrum of diseases, and emergency radiologists play a critical role in disease management by providing a timely diagnosis. Documenting the location of a gallstone within the common bile duct (CBD) in symptomatic cholelithiasis and the presence of acute interstitial edematous pancreatitis and/or ascending cholangitis plays a pivotal role in disease management. Establishing the presence of ectopic gallstones and biliary-enteric fistulae has a significant role in directing patient management.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Carrie Hoff
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
| | | | - Arie Neymotin
- Department of Radiology, MedStar Health, Washington, DC, USA
| | - Kiran Maddu
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
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Gazali Z, Kumar R, Rai PK, Rai PK, Rai AK, Thakur SN. Discrimination of gallbladder stone employing Laser-Induced Breakdown Spectroscopy (LIBS) and Photoacoustic Spectroscopy (PAS). Spectrochim Acta A Mol Biomol Spectrosc 2021; 260:119948. [PMID: 34030035 DOI: 10.1016/j.saa.2021.119948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/04/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
Compositional analysis of gallstone samples has been carried out, using Laser-Induced Breakdown Spectroscopy (LIBS) and Photoacoustic Spectroscopy (PAS). Classification of gallstone has been made on the basis of intensities of the inorganic and organic constituents present in the LIBS spectra. A regression plot is drawn between LIBS spectral intensities of organic & inorganic elements and the stoichiometric ratio of Cholesterol, Bilirubin and Calcium Carbonate. Atomic lines of various elements, as well as molecular signatures of CaO Orange band, CN Violet band, and C2 Swan band, are observed in LIBS spectra. The relative hardness of gallstones is estimated from the intensity ratio of ionic to neutral atomic lines of the species observed in LIBS spectra. PAS is used for detecting molecular constituents in the gallstones. Principal Component Analysis (PCA) is performed for the discrimination of gallstones. It is found that PAS data, in combination with LIBS provide a suitable method for the compositional analysis of gallstones.
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Affiliation(s)
- Zainab Gazali
- Laser and Spectroscopy Research Laboratory, Physics Department, University of Allahabad, Prayagraj, India
| | - Rohit Kumar
- Department of Physics, Chaudhary Mahadeo Prasad Degree College, Prayagraj, India
| | | | | | - Awadhesh K Rai
- Laser and Spectroscopy Research Laboratory, Physics Department, University of Allahabad, Prayagraj, India.
| | - Surya N Thakur
- Physics Department, Banaras Hindu University, Varanasi, India
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Jang H, Park CH, Park Y, Jeong E, Lee N, Kim J, Jo Y. Spontaneous resolution of gallbladder hematoma in blunt traumatic injury: A case report. World J Clin Cases 2021; 9:8518-8523. [PMID: 34754862 PMCID: PMC8554416 DOI: 10.12998/wjcc.v9.i28.8518] [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: 04/06/2021] [Revised: 05/12/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury. We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography (ERCP).
CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior. Four days prior to presentation, the patient had slipped, fallen and struck his abdomen on a motorcycle handle. His initial vital signs were stable. On physical examination, he showed right upper quadrant pain and Murphy’s sign, with decreased bowel sounds. Additionally, he had had a poor appetite for 4 d. He had been on aspirin for 2 years due to underlying hypertension. Initial simple radiography revealed a slight ileus. The laboratory findings were as follows: white blood cell count, 15.5 × 103/µL (normal range 4.8 × 103–10.8 × 103); hemoglobin, 9.4 g/dL; aspartate aminotransferase/alanine transferase, 423/348 U/L; total bilirubin/direct bilirubin, 4.45/3.26 mg/dL; -GTP , 639 U/L (normal range 5–61 U/L); and C-reactive protein, 12.32 mg/dL (0–0.3). Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm × 40 mm hematoma. Dilatation was observed in both the intrahepatic and common bile duct areas. Antibiotic treatment was initiated, and ERCP was performed, with hemobilia found during treatment. After cannulation, the patient’s symptoms were relieved, and after conservative management, the patient was discharged with no further complications. After 1-month follow-up, the gallbladder hematoma was completely resolved.
CONCLUSION In the case of traumatic injury to the gallbladder, conservative treatment is feasible even in the presence of hematoma.
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Affiliation(s)
- Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Chang-Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
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Ghartimagar D, Jhunjhunwala AK, Ghosh A, Shrestha MK. Thirty-five cases of gallbladder carcinoma out of 4914 cholecystectomy specimens from a Nepalese tertiary care hospital - A retrospective cohort study. Ann Med Surg (Lond) 2021; 69:102753. [PMID: 34484725 PMCID: PMC8405908 DOI: 10.1016/j.amsu.2021.102753] [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] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The density of gallbladder carcinoma differs in different parts of the world. It is an aggressive tumor with poor prognosis presenting in advanced stages due to paucity of signs and symptoms. This research was conducted to analyze the frequency of incidental and clinically suspected gallbladder carcinoma with clinicopathological correlation. Methods This is a retrospective cohort study conducted in the Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal from January 2005 to December 2020. Results The study included 35 cases of gallbladder carcinoma compiled over a period of 16 years. There were 11 males and 24 females with a male to female ratio of 1: 2.1. Age ranged from 29 to 75 years with a mean age of 56.51 ± 11.38 years. Incidental carcinoma was observed in 26 (74.28%) cases while clinically suspected carcinoma was identified in 9 (25.71%) cases. Gallstone was associated in 14 (40%) cases of incidental carcinoma. Tumor staging of both incidental and clinically suspected carcinomas showed 13 (37.14%) cases in T1 stage, 15 (42.85%) cases in T2 stage and 7(20%) cases in T3 stage. Conclusion Our analysis established prevalance of gallbladder carcinoma from 5th to 7th decades with female predominance and higher association of gallstones in incidental carcinoma. The principal histology in incidental carcinoma was well differentiated carcinoma while poorly differentiated carcinoma was encountered only in clinically suspected carcinoma. Gallbladder carcinoma is an aggressive tumor with poor prognosis. Early diagnosis of gallbladder carcinoma is rare. Incidental carcinomas are more frequent than clinically suspected carcinomas. Incidental carcinomas have more association with gallstones. Clinically suspected carcinoma shows higher stage of tumor.
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Affiliation(s)
- Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | | | - Arnab Ghosh
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
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Lindqvist L, Sandblom G, Nordin P, Hemmingsson O, Enochsson L. Regional variations in the treatment of gallstone disease may affect patient outcome: a large, population-based register study in sweden. Scand J Surg 2021; 110:335-343. [PMID: 33106126 PMCID: PMC8551430 DOI: 10.1177/1457496920968015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The lack of studies showing benefit from surgery in patients with symptoms of gallstone disease has led to a divergence in local practices and standards of care. This study aimed to explore regional differences in management and complications in Sweden. Furthermore, to study whether population density had an impact on management. METHODS Data were collected from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Cholecystectomies undertaken for gallstone disease between January 2006 and December 2017 were included. Age, sex, American Society of Anesthesiologists (ASA) classification, intra- and post-operative complications, and the proportion of patients with acute cholecystitis who underwent surgery within 2 days of hospital admission were analyzed. The 21 different geographical regions in Sweden were compared, and each variable was analyzed according to population density. RESULTS A total of 139,444 cholecystectomies cases were included in this study. There were large differences between regions regarding indications for surgery and intra- and post-operative complications. In the analyses, there were greater divergences than would be expected by chance for most of the variables analyzed. Age of the cholecystectomized patients correlated with population density of the regions (R2 = 0.310; p = 0.0088). CONCLUSIONS There are major differences between the different regions in Sweden in terms of the treatment of gallstone disease and outcome, but these did not correlate to population density, suggesting that local routines are more likely to have an impact on treatment strategies rather than demographic factors. These differences need further investigation to reveal the underlying causes.
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Affiliation(s)
- Lisa Lindqvist
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Gabriel Sandblom
- Surgery, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Pär Nordin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Oskar Hemmingsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Lars Enochsson
- Professor of Surgery, Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, SE-901 87, Sweden
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Maringhini A, Dardanoni G, Fantaci G, Patti R, Maringhini M. Acute Pancreatitis During and After Pregnancy: Incidence, Risk Factors, and Prognosis. Dig Dis Sci 2021; 66:3164-3170. [PMID: 33085013 DOI: 10.1007/s10620-020-06608-5] [Citation(s) in RCA: 3] [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: 02/09/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute pancreatitis may complicate pregnancy and both are associated with gallstones, but its incidence is not well known. AIMS To validate hospital discharge records in diagnosing acute pancreatitis and gallstones and to evaluate acute pancreatitis incidence in non pregnant, pregnant and after delivery using hospital discharge records METHODS: We identified all hospital discharge records of hospitalized Sicilian women of childbearing age (2011-2016). We determined agreement between 300 hospital discharge records and hospital records in diagnosing acute pancreatitis and gallstones. Acute pancreatitis incidence, prognosis, and their relationship with age and gallstones were calculated in the three groups using hospital discharge records. RESULTS There was 92% and 88% agreement in diagnosing acute pancreatitis and gallstones between hospital discharge and hospital records. In non pregnant, 1,564 of 7,236,863 women-years (21.61/100,000 person-years) developed acute pancreatitis. During pregnancy, 34 of 226,492 women-years developed acute pancreatitis (20.02/100,000 person-years). Postpartum acute pancreatitis incidence was higher than non pregnant, only in the first 2 years with the peak in the first semester (95.4/100,000 person-years). The increased incidence of postpartum acute pancreatitis was associated with gallstones in youngest women (gallstones acute pancreatitis in women below 20 years old versus non pregnant: rate ratios 16.61; 95% CI 8.40-32.87). CONCLUSIONS Agreement in acute pancreatitis and gallstones diagnosis between hospital discharge and hospital records was accurate. Acute pancreatitis incidence was increased only in the first 2 years after delivery in young women with gallstones.
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Affiliation(s)
- Alberto Maringhini
- Dipartimento Medicina, ARNAS Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy.
| | - Gabriella Dardanoni
- Dipartimento per le Attività Sanitarie ed Osservatorio Epidemiologico, Regione Sicilia, Via Vaccaro, 5, 90145, Palermo, Italy
| | - Giovanna Fantaci
- Dipartimento per le Attività Sanitarie ed Osservatorio Epidemiologico, Regione Sicilia, Via Vaccaro, 5, 90145, Palermo, Italy
| | - Rosalia Patti
- Dipartimento Medicina, ARNAS Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - Marco Maringhini
- Dipartimento di Medicina Interna, Università di Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Di Martino M, Mora-Guzmán I, Vaello Jodra V, Sanjuanbenito Dehesa A, Morales-García D, Caiña Ruiz R, García-Moreno Nisa F, Mendoza-Moreno F, Alonso Batanero S, Quiñones Sampedro JE, Lora Cumplido P, Arango Bravo A, Rubio-Perez I, Asensio-Gomez L, Pardo Aranda F, Sentí I Farrarons S, Ruiz Moreno C, Martinez Moreno CM, Sarriugarte Lasarte A, Prieto Calvo M, Aparicio-Sánchez D, Perea Del Pozo E, Martin-Perez E. Laparoscopic cholecystectomy for acute cholecystitis: is the surgery still safe beyond the 7-day barrier? A multicentric observational study. Updates Surg 2021; 73:261-72. [PMID: 33211289 DOI: 10.1007/s13304-020-00924-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Timing for early laparoscopic cholecystectomy (ELC) in patients with acute calculous cholecystitis (ACC) is still controversial. This study assesses ELC for ACC with delayed presentation, according to hospital volume. Multicentric retrospective analysis of 1868 ELC. Patients were classified into two groups according to the timing of surgery from clinical onset and centre volume. Group 1 (G1) within the first 7 days, group 2 (G2) beyond that. Then centres were classified in low volume centres (LVC) and higher volume centres (HVC) according to the number of ELC performed per year. Overall, G2 showed increased conversion rate (17.7% vs 10.7%; p = 0.004), intraoperative complications (7.3% vs 2.9%; p = 0.001); postoperative haemorrhage (3.6% vs 0.8%; p < 0.001), infections (16.6% vs 9.3%; p = 0.003) and global complications (27.6% vs 19.8%; p = 0.011). HVC in comparison with LVC presented decreased conversion rate (17.1% vs 7.6%; p < 0.001), intraoperative bleeding (2.1% vs 1%; p = 0.047), postoperative bile leakage (4.1% vs 2.1%; p = 0.011), infectious (13.7% vs 7.5%; p < 0.001) and global complications (25.7% vs 17.1%; p < 0.001). HVC did not show an increase in any of the above-mentioned outcomes when G1 and G2 were compared. ELC must be indicated cautiously in patients with ACC and more than 1 week of symptom duration. It should be performed in centres with sufficient experience in the management of this disease.
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Wu CH, Huang KH, Chen MH, Fang WL, Chao Y, Lo SS, Li AFY, Wu CW, Shyr YM. Comparison of the Long-term Outcome Between Billroth-I and Roux-en-Y Reconstruction Following Distal Gastrectomy for Gastric Cancer. J Gastrointest Surg 2021; 25:1955-1961. [PMID: 33205309 DOI: 10.1007/s11605-020-04867-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/18/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Various reconstruction methods have been performed following distal gastrectomy; however, each reconstruction method has its own advantages and disadvantages. This study aims to compare the long-term outcomes between Billroth-I (B-I) and Roux-en-Y (RY) reconstruction after distal gastrectomy for gastric cancer. METHODS A total of 459 patients who underwent distal gastrectomy (B-I: 166, RY: 293) were included. Postoperative endoscopic findings and biliary tract stone formation were compared between the two groups. RESULTS At 1 year and 2 years postoperatively, gastric residue was more common in the RY group, gastritis was similar between groups, and bile reflux was more common in the B-I group. At 5 years postoperatively, gastric residue was similar between the groups, while gastritis and bile reflux were more common in the B-I group. Gastroesophageal reflux was more common in the B-I group at 1 year postoperatively, but gastroesophageal reflux became not significantly different between the groups at 2 and 5 years postoperatively. Gallstone formation was more common in the RY group and in patients aged ≥ 65 years. CONCLUSION During long-term follow-up, RY reconstruction was associated with lower incidence of bile reflux and gastritis, and higher incidence of gallstone formation than B-I reconstruction. The incidence of gastric residue was more common in the RY reconstruction group in the early postoperative period and became not significantly different between the two groups over time. For aged patients with RY reconstruction, cholecystectomy is recommended concurrently as gastrectomy.
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Affiliation(s)
- Chia-Hung Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Huang Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yee Chao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,National Yang-Ming University Hospital, Yilan, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chew-Wun Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
Abscess of the ligamentum teres is one of the rarest causes of acute abdomen and causes severe dilemma and real challenge in clinching the diagnosis. A 69-year-old lady with severe upper abdominal pain with history of gall stones underwent MRI upper abdomen and was diagnosed as abscess of the ligamentum teres. There are only very few reported cases of this entity in the literature.
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Affiliation(s)
- Kaushik Bhattacharya
- CAPFs Composite Hospital BSF Kadamtala, G616, Uttorayon, Matigara, Siliguri, 734010 West Bengal India
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45
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Abdullah BH, Jassam SA, Hadi WA, Hameed B. Gallbladder stone formation in Iraqi patients is associated with bacterial infection and HLA class II-DRB1 antigens. INDIAN J PATHOL MICR 2021; 63:570-574. [PMID: 33154307 DOI: 10.4103/ijpm.ijpm_841_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/07/2022] Open
Abstract
Background Gallbladder stone is recently increased among the Iraqi society due to many risk factors such as bacterial infection and some HLA class II antigens. Aim(s) This study investigates the types of bacterial infection and HLA-DRB1 antigens' ratio that may be correlated with gallbladder stone formation. Setting and Design: The study included 45 patients and the same number of healthy individuals as a control group. Patients were with multiple gallstones. Gallstone bacterial culture was demonstrated to diagnose viable bacteria. HLA-DRB1 alleles' frequency was investigated using sequence-specific oligonucleotide probes (PCR-SSOP). Results Irrespective of gallstone type and size, different types of living viable bacteria were isolated from the cores of the studied gallstones in 80% of the studied cases versus 20% of sterile gallstones. Gram-negative bacteria cultures were the dominant (89.3%), including Escherichia coli, Klebsiella spp., Proteus spp., Acinetobacter spp., and Enterobacter spp. Mixed infection of Gram-positive and negative bacteria was noted: Escherichia coli and Enterococus spp. and the others of Escherichia coli and Acitobacter spp., and Klebsiella spp. and Pseudomonas spp. Gram-positive bacteria cultures were also detected at lower rate (10.7%) including Staphylococci spp. The frequency of HLA-DRB1*03:01, HLA-DRB1*4:03, HLA-DRB1*13:22, and HLA-DRB1*15:10 alleles was significantly elevated in patients compared to the healthy control group. Conclusion Results ensured the viability of the bacteria isolated from the core of gallstones and showed positive correlation between gallbladder stone and different bacterial infection. In addition, HLA-DRB1 alleles were significantly high in patients compared to healthy control group suggesting them as risk factors (P < 0.05).
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Affiliation(s)
- Baydaa H Abdullah
- Depatment of Clinical Laboratory Science, Pharmacy College, Mustansiryah University, Baghdad, Iraq
| | - Samah A Jassam
- Depatment of Clinical Laboratory Science, Pharmacy College, Mustansiryah University, Baghdad, Iraq
| | - Wafaa A Hadi
- Department of Pathology, Teaching Hospital of Kadhimiya, Baghdad, Iraq
| | - Bassam Hameed
- Department of Surgery, Teaching Hospital of Al-Yarmouk, Baghdad, Iraq
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46
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Prencipe N, Bona C, Cuboni D, Parasiliti-Caprino M, Berton AM, Fenoglio LM, Gasco V, Ghigo E, Grottoli S. Biliary adverse events in acromegaly during somatostatin receptor ligands: predictors of onset and response to ursodeoxycholic acid treatment. Pituitary 2021; 24:242-251. [PMID: 33164134 PMCID: PMC7966199 DOI: 10.1007/s11102-020-01102-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Somatostatin receptor ligands (SRL) are the first-line medical treatment for acromegaly. Gallbladder alterations are one of most important SRL side effect, but according to some authors growth hormone hypersecretion itself is a risk factor for gallstones. This single center, longitudinal retrospective study evaluated the incidence and the predictors of biliary adverse events (BAE) in acromegaly during SRL therapy and their response to ursodeoxycholic acid (UDCA). METHODS 91 acromegaly patients with indication to SRL were enrolled. Evaluations of acromegaly activity (GH, IGF-I, IGF-I/ULN) and metabolic profile were collected before starting treatment, yearly during follow-up and at BAE onset. In patients developing BAE we searched for predictors of UDCA effectiveness. RESULTS 61.5% of patients developed BAE (58.9% cholelithiasis; 41.1% only sludge). IGF-I and IGF-I/ULN proved to be positive predictor of BAE, which occur about 5 years after SRL starting. None of metabolic markers proved to be associated with BAE. Only five patients (5.5%) underwent cholecystectomy for symptomatic cholelithiasis. 71% of patients started UDCA treatment, achieving regression of BAE in 60% of cases (88% in patients developing only sludge and 30% in patients affected by cholelithiasis, p < 0.001). BMI and obesity were negative predictors of UDCA efficacy. In 50% of the subjects BAE resolved after 36 months of therapy with a lower rate if cholelithiasis was present. CONCLUSION Biliary stone disease is a frequent SRL adverse event, although it is often symptomless. Ultrasound follow-up mainly in the first 5 years of therapy, early UDCA starting and proper lifestyle represent a valid strategy in their detection and management.
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Affiliation(s)
- N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - D Cuboni
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Parasiliti-Caprino
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - A M Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - L M Fenoglio
- Division of Internal Medicine, Santa Croce and Carle General Teaching Hospital, Cuneo, Italy
| | - V Gasco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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47
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Asare OK, Obaka HE, Affram NK. Gallstone ileus: a rare type of intestinal obstruction in Ghana. Ghana Med J 2021; 55:84-87. [PMID: 38322390 PMCID: PMC10665272 DOI: 10.4314/gmj.v55i1.13] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Gallstone ileus is an uncommon cause of intestinal obstruction in Ghana. A patient with gallstone ileus that was diagnosed intra-operatively after being treated conservatively as adhesive small bowel obstruction for ten days is reported to highlight the importance of the clinical information in this condition. A 60-year-old Chinese male with recurrent intestinal obstruction who was initially being managed at a primary healthcare facility was subsequently referred to a tertiary hospital on account of computer tomography diagnosis of an intraluminal object obstructing the bowel. He had hypokalaemia that was corrected before surgery. Intra-operatively, a 4.5cm in diameter gallstone was removed from the terminal ileum. Gallstone ileus is rare in Ghana. A high index of suspicion is required to avoid a delay in diagnosis due to the low incidence of cholelithiasis in Ghana. Funding None declared.
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Affiliation(s)
- Offei K Asare
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Henry E Obaka
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
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Hajibandeh S, Finch DA, Mohamedahmed AYY, Iskandar A, Venkatesan G, Hajibandeh S, Satyadas T. Meta-analysis and trial sequential analysis of three-port vs four-port laparoscopic cholecystectomy (level 1 evidence). Updates Surg 2021; 73:451-471. [PMID: 33587285 DOI: 10.1007/s13304-021-00982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023]
Abstract
To compare the outcomes of three-port and four-port laparoscopic cholecystectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port vs four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model. The risks of type 1 or type 2 error in the meta-analysis model were assessed using trial sequential analysis model. The certainty of evidence was assessed using GRADE system. Random effects modelling was applied to calculate pooled outcome data. Analysis of 2524 patients from 17 studies showed that both techniques were comparable in terms of operative time (MD:- 0.13, P = 0.88), conversion to open operation (OR:0.80, P = 0.43), gallbladder perforation (OR: 1.43, P = 0.13), bleeding from gallbladder bed (OR:0.81, P = 0.34), bile duct injury (RD: 0.00, P = 0.97), iatrogenic visceral injury (RD: - 0.00, P = 0.81), bile or stone spillage (OR:1.67, P = 0.08), port site infection (OR: 0.90, P = 0.76), port site hernia (RD: 0.00, P = 0.89), port site haematoma (RD: - 0.01, P = 0.23), port site seroma (RD: 0.00, P = 1.00), and need for reoperation (RD: - 0.00, P = 0.94). However, the three-port technique was associated with lower VAS pain score at 12 h (MD: - 0.66, P < 0.00001) and 24 h (MD: - 0.54, P < 0.00001) postoperatively, shorter length of hospital stay (MD:-0.09, P = 0.41), and shorter time to return to normal activities (MD: - 0.79, P = 0.02). Trial sequential analysis confirmed that the meta-analysis was conclusive with no significant risks of type 1 or type 2 error. Robust evidence (level 1 with high certainty) suggests that in an elective setting with uncomplicated cholelithiasis as indication for cholecystectomy, three-port laparoscopic cholecystectomy is comparable with the four-port technique in terms of procedural and morbidity outcomes and may be associated with less postoperative pain, shorter length of hospital stay and shorter time to return to normal activities.
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Affiliation(s)
- Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, Cardiff, UK. .,Department of General Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, UK.
| | - David A Finch
- Department of General Surgery, Pinderfields General Hospital, Wakefield, UK
| | | | - Amir Iskandar
- Department of General Surgery, North Manchester General Hospital, North Manchester Care Organisation, Manchester, UK
| | - Gowtham Venkatesan
- Department of General Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Thomas Satyadas
- Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital, Manchester, UK
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49
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Mitra T, Dixit VK, Yadav DP, Shukla SK, Verma A, Thakur P, Thakur R. Idiopathic acute pancreatitis-A myth or reality? Role of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in its diagnosis. Indian J Gastroenterol 2021; 40:22-29. [PMID: 33548019 DOI: 10.1007/s12664-020-01125-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/12/2020] [Accepted: 11/12/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Around 10% to 30% patients with acute pancreatitis (AP) do not have a cause after the routine investigations, and are considered as having idiopathic acute pancreatitis (IAP). Establishing the etiology in such patients will prevent recurrences and evolution to chronic pancreatitis. Endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) characteristically are used to diagnose IAP when routine methods fail, but their exact role is not determined. METHODS This prospective study was undertaken in a tertiary care hospital, in which patients admitted initially with diagnosis of IAP were evaluated. These patients underwent MRCP and EUS at least 4 weeks after an attack of AP. The results of EUS and MRCP were compared and analyzed with various clinical variables using suitable statistical tests. RESULTS A total of 31 patients with IAP were included. EUS and/or MRCP was able to establish at least one etiology in 17 patients (54.8%). The diagnoses revealed were gallbladder (GB) microlithiasis, GB sludge, choledocholithiasis, pancreatobiliary ductal anomalies, pancreatic adenocarcinoma, and intraductal papillary mucinous neoplasm. Comparing the diagnostic accuracy of both the modalities, EUS (14/31) was able to diagnose more cases than MRCP (8/31). The diagnostic capability of EUS was lower in patients who had a cholecystectomy (12.5% vs. 56.5%; p = 0.03). CONCLUSIONS EUS and MRCP are useful modalities in the etiological diagnosis of IAP and should be used in conjunction. EUS is better for establishing a possible biliary etiology and MRCP for an anatomical alteration in pancreatobiliary ducts.
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Affiliation(s)
- Tuhin Mitra
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Vinod Kumar Dixit
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India.
| | - Dawesh Prakash Yadav
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Sunit Kumar Shukla
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Piyush Thakur
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Ravikant Thakur
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
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50
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He YG, Gao MF, Li J, Peng XH, Tang YC, Huang XB, Li YM. Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature. World J Clin Cases 2021; 9:736-747. [PMID: 33553415 PMCID: PMC7829737 DOI: 10.12998/wjcc.v9.i3.736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/15/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Choledocholithiasis removal via endoscopic retrograde cholangiopancreatography (ERCP) then followed by laparoscopic cholecystectomy (LC) has gradually become the principal method in the treatment of gallstones and choledocholithiasis. We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis, with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury.
CASE SUMMARY A total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP. The efficacy was evaluated via operation success rate, calculus removal rate, postoperative hospital stay and average hospitalization costs; the safety was evaluated through perioperative complication probability, gallbladder function detection and gallstones recrudesce. The calculus removal rate reached 100%, and patients had mild adverse events, including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase; both were relieved after corresponding treatment, the remaining cases had no complications. The average hospital stay and hospitalization costs were 6.16 ± 1.47 d and 5194 ± 696 dollars. The 3-11 mo follow-up revealed that gallbladder contracted well, without recurrence of gallstones.
CONCLUSION This is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity. The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.
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Affiliation(s)
- Yong-Gang He
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Ming-Fa Gao
- Department of Hepatobiliary, North-Kuanren General Hospital, Chongqing 401121, China
| | - Jing Li
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xue-Hui Peng
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Yi-Chen Tang
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xiao-Bing Huang
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Yu-Ming Li
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
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