Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study.

Abstract

Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available. We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors. RELAPSTONE was an international multicenter retrospective cohort study. Patients (n=3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses. Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3months, 0.71 (95% CI: 0.69-0.73) at 6months, and 0.63 (95% CI: 0.61-0.65) at 12months. In multivariable analysis, older age (HR=0.57; 95% CI: 0.49-0.66), sphincterotomy (HR=0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR=0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR=1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR=1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates. The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.