Abstract
BackgroundShort-term studies have shown that patients with type III intestinal failure often develop gallstones and have recommended prophylactic cholecystectomy. In this retrospective cohort study, we aimed to define the incidence and clinical consequences of cholelithiasis over an extended time period, in order to refine the role of prophylactic cholecystectomy in type III intestinal failure. MethodsData were retrospectively collected from a prospectively maintained audit. Patients with intestinal failure for 5 years or more were included. Kaplan-Meier analysis was used to estimate cumulative incidence over time. Predictors of cholelithiasis were evaluated by Cox regression. ResultsBetween 1 January 1983 and 1 December 2008, 81 patients were commenced on parenteral support lasting 5 years or more. Of 63 patients with no pre-existing gallstones on imaging, 17 (27%) developed gallstones during a median observation period of 133 months. On Kaplan-Meier analysis, the incidence at 10 years was 21%; at 20 years, 38%; and at 30 years, 47%. Thirteen of the 17 had symptoms and ten required surgical and/or endoscopic intervention. Increased weekly calorific content (P 0.003) and the provision of parenteral lipids (P 0.003) were predictors of cholelithiasis on univariable Cox regression. ConclusionMany patients with long-term intestinal failure develop gallstones over time, with a 20-year incidence of 38%. The majority of those have symptoms or complications and require intervention. Therefore, prophylactic en-passant cholecystectomy is justified when gallstones are present in type III intestinal failure, supporting routine pre-operative imaging of the gallbladder prior to abdominal surgery.
Highlights
The prevalence of cholelithiasis in the UK adult population is between 10 and 15%, with the majority of patients being asymptomatic.[1]
The aim of the current study was to provide comprehensive, longitudinal, and long-term data on the incidence of symptomatic and asymptomatic cholelithiasis and gallstonerelated intervention and complications in a cohort of patients with type III intestinal failure (IF), in order to define the incidence of gallstone disease and provide a more rational evidence base to support decisions regarding the role of prophylactic cholecystectomy in this patient group
Was cholelithiasis found to be frequent in type III intestinal failure, but the majority of patients who developed gallstones in the present study had clinical manifestations of their disease
Summary
The prevalence of cholelithiasis in the UK adult population is between 10 and 15%, with the majority of patients being asymptomatic.[1]. Because of the perceived increase in gallstone-related morbidity in type III IF, prophylactic cholecystectomy has been advocated. Some authors have recommended en-passant cholecystectomy during abdominal surgery in patients with IF and gallstones[5] or even in all IF patients, irrespective of whether or not they have gallstones.[6,7] Some authors have gone even further, to advocate undertaking a separate, prophylactic cholecystectomy in patients who are found to have developed gallstones during ultrasound surveillance[6] or even in all patients with type III IF.[8] These recommendations were. Short-term studies have shown that patients with type III intestinal failure often develop gallstones and have recommended prophylactic cholecystectomy. In this retrospective cohort study, we aimed to define the incidence and clinical consequences of cholelithiasis over an extended time period, in order to refine the role of prophylactic cholecystectomy in type III intestinal failure
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