Epidemiology of Gallstones

Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder disease. However, few studies have reported the difficulty of interval cholecystectomy after cholecystitis because early cholecystectomy is recommended for acute cholecystitis. In this study, we evaluated the difficulties associated with interval cholecystectomy for cholecystitis with gallstones.

We retrospectively analyzed patients with gallstones who underwent interval laparoscopic cholecystectomy for cholecystitis at our institution between January 2012 and December 2021. Patients were classified into laparoscopic total cholecystectomy and bailout procedure groups depending on whether they were converted to a bailout procedure, and their characteristics and outcomes were subsequently compared. Additionally, a logistic regression analysis of the preoperative factors contributing to bailout procedure conversion was performed.

Of the 269 participants, 39 converted to bailout procedure, and bile duct injury occurred in one case (0.4%). In patient characteristics comparison, patients in the bailout procedure group were significantly older, had more impacted stones, had higher post-treatment choledocholithiasis, had severe cholecystitis, and had a higher rate of percutaneous transhepatic gallbladder drainage. There were no differences in the bile duct injury or perioperative complications between the two groups. In logistic regression multivariate analysis of the factors contributing to the bailout procedure, post-treatment of choledocholithiasis (P < .001), impacted stone (P = .002), and age ≥71 (P = .007) were independent risk factors.

Impacted stones and choledocholithiasis are risk factors for conversion to bailout procedure and high difficulty in interval cholecystectomy. For such patients, interval cholecystectomy should be performed cautiously.

Gallstones are common and associated with substantial health and economic burden. We aimed to comprehensively evaluate the prevalence and incidence of gallstones in the 21st century.

We systematically searched PubMed and Embase to identify studies reporting the prevalence and/or incidence of gallstones between January 1, 2000, and November 18, 2023. Pooled prevalence and incidence were calculated using DerSimonian and Laird’s random-effects model. We performed subgroup analyses and meta-regression based on age, sex, geographic location, population setting, and modality of detection to examine sources of heterogeneity.

Based on 115 studies with 32,610,568 participants, the pooled prevalence of gallstones was 6.1% (95% CI, 5.6–6.5). Prevalence was higher in females vs males (7.6% vs 5.4%), in South America vs Asia (11.2% vs 5.1%), in upper-middle-income countries vs high-income countries (8.9% vs 4.0%), and with advancing age. On sensitivity analysis of population-based studies, the prevalence of gallstones was 5.5% (95% CI, 4.1–7.4; n = 44 studies), and when limiting subgroup analysis to imaging-based detection modalities, the prevalence was 6.7% (95% CI, 6.1–7.3; n = 101 studies). Prevalence has been stable over the past 20 years. Based on 12 studies, the incidence of gallstones was 0.47 per 100 person-years (95% CI, 0.37–0.51), without differences between males and females, and with increasing incidence in more recent studies.

Globally, 6% of the population have gallstones, with higher rates in females and in South America. The incidence of gallstones may be increasing. Our findings call for prioritizing research on the prevention of gallstones.

Cholecystectomy alters bile flow and quality which might compromise the absorption of vitamin D and vitamin K which are important for bone health. We aimed to assess the risk of osteoporosis after cholecystectomy.

We performed a nationwide, register-based, cohort study using individual-level data from the Danish Health Registers. Individuals who had cholecystectomy performed between 1995 and 2017 were included as were five sex- and aged-matched controls for each case. We assessed fractures, ICD diagnosis of osteoporosis and osteoporosis treatments. We defined a composite endpoint for osteoporosis consisting of 1) hip or spine fractures, 2) ICD diagnosis of osteoporosis or 3) osteoporosis treatments.

We included 149.968 cases and 727.456 controls that were followed for a median of 9 years (inter-quartile range 4–15 years). In the cholecystectomy cohort, 6.4 % reached the composite endpoint compared to 6.6 % in the reference population (HR 0.98 (0.96–1.03)). In age-stratified analyses, minor risk increases were observed in the cholecystectomy cohort compared to the reference population in the composite endpoint for osteoporosis (age group ≤30 years, 0.8 % vs. 0.6 %, HR 1.42 (1.19–1.71)), fractures rates (≤30 years incidence rate ratio (IRR) 1.38 (1.32–1.43), age group 31–50 years IRR 1.10 (1.08–1.43)) and ICD osteoporosis diagnosis (≤30 years, 0.3 % vs. 0.2 % HR 1.40 (1.04–1.87)).

The risk of osteoporosis was similar in patients with prior cholecystectomy and controls. In younger subgroups, the risk of osteoporosis and fractures was slightly increased but absolute risks were low. These findings do not support that cholecystectomy leads to any major calcium-metabolic disturbances.

La esteatosis hepática metabólica (EHMet) y la colelitiasis son entidades que comparten factores de riesgo similares. Numerosas publicaciones confirman su elevada frecuencia, sin embargo, pocos estudios han considerado su prevalencia y posible asociación.

Determinar la prevalencia de EHMet en pacientes con colelitiasis y la utilidad de la biopsia hepática para el diagnóstico de la enfermedad.

Estudio prospectivo de pacientes tratados mediante colecistectomía laparoscópica a los cuales se realizó biopsia hepática.

Características antropométricas, perfil bioquímico, ultrasonido convencional, factores de riesgo y estudio histopatológico de biopsia hepática.

Se emplearon estadísticas descriptivas para variables cuantitativas y t de Student y análisis multivariado mediante regresión logística binaria para variables continuas, empleando el programa IBM-SPSS, 25.0 (Windows).

Ciento treinta y seis pacientes, clasificados en 2 grupos: hígado normal 40 (29.41%) y EHMet 96 (70.59%) de ellos 71 (52.21%) correspondieron a esteatosis hepática, 21 (15.44%) a esteatohepatitis y 4 (2.94%) a cirrosis. En 39 casos (28.68%) se encontró inflamación perisinusoidal y en 10 (7.35%) fibrosis. Los factores de riesgo para ambos grupos fueron edad, diabetes, hipertensión arterial y obesidad; los niveles de glucosa, triglicéridos y aminotransferasas fueron significativamente superiores en EHMet y el ultrasonido convencional fue un estudio de moderada concordancia para su detección.

Los resultados confirman la elevada frecuencia de EHMet asociada a colelitiasis por lo cual se justifica realizar la biopsia hepática durante la colecistectomía para establecer su diagnóstico.

Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association.

To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease.

A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed.

Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy.

Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software.

A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection.

The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Gallstone disease remains a major health issue. There have been significant changes in the management and demographics of patients with these conditions. We aimed to evaluate trends in hospitalization, management, and post-procedural adverse events for patients with gallstone disease.

The National Inpatient Sample was used to identify discharges for symptomatic cholelithiasis and cholecystitis between 2005 and 2014. Temporal trends were evaluated by calculating annual percent changes (APCs). Joinpoint regression was used to assess inflection points. Multivariable regression models were used to evaluate associations between urban and rural divisions and mortality, use of interventional procedures, and post-procedural adverse events.

From 77,394,755 unweighted discharges, there was a decline in discharges for cholelithiasis (APC − 5.5%, 95% confidence intervals, CI, − 7.6 to − 3.4%) and cholecystitis from 2012 to 2014 (APC − 4.5%, 95% CI − 7.2 to − 1.7%). Interventions were more likely at urban hospitals for symptomatic cholelithiasis (odds ratio, OR, 1.49, 95% CI 1.24 to 1.66) and cholecystitis (OR 1.96, 95% CI 1.86 to 2.05). In-hospital mortality significantly decreased annually for patients with cholecystitis (OR 0.92, 95% CI 0.91 to 0.93). In-hospital mortality between rural and urban centers was comparable for symptomatic cholelithiasis (OR 1.27, 95% CI 0.79 to 2.03) and cholecystitis (OR 0.93, 95% CI 0.84 to 1.04).

Hospitalizations for gallstone disease have decreased since the 2010s. In-hospital mortality between urban and rural centers is similar, but urban hospitals utilize a higher rate of procedural interventions. Future studies should evaluate practice trends and costs across inpatient and ambulatory settings between rural and urban divisions.

The aim of this study was to evaluate the safety of urgent laparoscopic cholecystectomy (Lap-C) for grade II acute cholecystitis (AC) in high-risk patients who were defined by Tokyo Guideline 18 as having age-adjusted Charlson comorbidity index ≥6 or American Society of Anesthesiologists physical status classification (ASA-PS) ≥ 3, compared with elective Lap-C following percutaneous transhepatic gallbladder drainage (PTGBD).

In 73 grade II AC patients who underwent Lap-C from January 2012 to March 2021, 35 were identified as high-risk; 22 underwent urgent Lap-C (urgent group) and 13 PTGBD followed by elective Lap-C (elective group). Surgical and perioperative outcomes were analyzed.

There was no significant difference in operation time (median: 101 min vs 125 min; P = 0.371), blood loss (25 ml vs 7 ml; P = 0.853), morbidity rate (31.8% vs 38.5%; P = 0.726), or the incidence of total perioperative major complications (13.6% vs 15.4%; P = 1.000) between the two groups. The total duration of treatment was significantly shorter in the urgent group than the elective group (11 days vs 71 days; P < 0.001). Multivariate analysis revealed that blood loss ≥45 ml [odds ratio (OS): 12.14, 95% confidence interval (CI): 2.03–72.42, P = 0.006], and age ≥75 years with ASA-PS ≥ 3 (OS: 9.85, 95%CI: 1.26–77.26, P = 0.03) were the independent risk factors for total perioperative major complications.

In well-selected high-risk patients with grade II AC, urgent Lap-C can be performed with comparable safety to elective Lap-C following PTGBD.