P049 Should the Gallbladder be Empirically Removed at Time of Intestinal Resection in Inflammatory Bowel Disease Patients?

Abstract

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of the gastrointestinal tract, which include Crohn's disease (CD) and ulcerative colitis (UC). Biliary complications are common amongst IBD patients. Up to 25% of patients with UC undergo colectomy and 50-75% of those with ileocolonic CD undergo intestinal resection. In this study, we aim to assess the prevalence of biliary disease (including cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, and biliary pancreatitis) in IBD patients who have had intestinal resection compared to non-IBD patients who also have had intestinal resection. Our study may inform clinical practice in the need to empirically perform a cholecystectomy in IBD patients who undergo intestinal resection. METHODS: This is a retrospective single-institution chart review of IBD and non-IBD patients with a history of intestinal resection. All adult patients, >18 years of age, who underwent an intestinal resection surgery between January 1, 2010 and December 31, 2017 were included in this study. Patients who had a cholecystectomy or presence of gallstones prior to intestinal resection were excluded from this study. For patients meeting inclusion criteria, demographic characteristics, as well as presence of IBD, and subtype of IBD were included from the patient’s medical records. Development of subsequent biliary disease, after intestinal resection, was identified via review of the medical records with special attention to abdominal imaging reports and operative reports. RESULTS: A total of 370 patients with intestinal resection were identified and included in the study. Of those patients, 20 (5.4%) had IBD: 6 with UC and 14 with CD. The 6 UC patients underwent intestinal surgery due to medically refractory disease. Of the 14 CD patients, 12 patient (85%) had surgery for inflammatory complications (including inflammatory masses, strictures and fistulas), only 1 patient (7%) underwent surgery for medically refractory disease, and another patient (7%) had surgery due to a right colonic adenocarcinoma. The majority of our IBD patients were males (85% of CD, 66% of UC). The majority of CD patients (85%) underwent ileal/ileocecal resection, with only 2 patients (14%) had a right hemicolectomy, whereas most UC patients (80%) underwent subtotal colectomy, with only 1 patient (16%) who underwent a total colectomy. Two out of the 20 IBD patients (10%) and 42 out of the 350 non-IBD patients (12%) developed gallstones after intestinal resection (P = 1.0). None of the IBD patients developed post-intestinal resection cholecystitis, cholangitis, choledocholithiasis or biliary pancreatitis compared to the ten, four, four and one non-IBD patients who did develop these complications respectively. There was no difference in numbers of cholecystectomy post-intestinal resection between non-IBD and IBD patients [34(9.7%) vs 2 (10%); P-value = 0.71]. CONCLUSION: Although our numbers are small, presence of IBD was not a significant risk factor for the development of biliary complications after intestinal resection. Our data shows that performing a cholecystectomy at the time of intestinal surgery is not warranted.