Development Of Gallstones Research Articles

Exploration of the Causal Association Between Behavioral Risk Factors and Gallstone Disease Development in Two European Ancestry Populations.

Introduction Risk factors for developinggallstones are related to disturbances in either cholesterol or bilirubin metabolism in the biliary tract. The risk of forming gallstones can be associated with chronic illnesses, dietary habits, reduced gallbladder motility, and medications. Our study aims to explore the causal relationship between multiple risk factors, including nutritional habits (cheese intake, salad intake, processed meat intake, coffee drinking), smoking behavior, overall obesity measured by body mass index (BMI), lipid biomarkers, total bilirubin and maternal diabetes mellitus (DM) and the development of gallstone disease in two different populations of European ancestry (United Kingdom Biobank (UKB) and FinnGen). Materials and methods Using publicly available genome-wide association studies (GWAS) data, we performed a two-sample Mendelian randomization (MR) to examine the association between risk factors and gallstonedevelopment.Exposures used in this study included age of smoking initiation, smoking intensity, coffee intake, cheese intake, salad intake, processed meat intake, BMI, and lipid biomarkers (cholesterol, low-density lipoproteins (LDL), triglycerides (TG), and high-density lipoproteins (HDL)).Current analyses were based on 93 single nucleotide polymorphisms (SNPs) for smoking initiation, four SNPs for smoking intensity, 65 SNPs for cheese intake, three SNPs for coffee intake, 22 SNPs for salad intake, 23 SNPs for processed meat intake, 79 SNPs for BMI, 26 SNPs for maternal DM, 89 SNPs for total bilirubin, 46 SNPs for cholesterol, 41 SNPs for LDL, 55 SNPs for TG, and 89 SNPs for HDL.The outcome in this study is gallstones/cholelithiasis. To evaluate the causal relationships between these risk factors and gallstones, two-sample MR methods were used. TwoSampleMR package in R software version 4.0.5 (R Foundation for Statistical Computing, Vienna, Austria) was used to obtain MR analyses and sensitivity analyses. Results In the UKB, genetic predispositions to smoking initiation, BMI, and total bilirubin were significantly associated with an increased risk of gallstones. The odds of gallstones would increase per 1-SD increase of genetically estimated smoking initiation (OR: 1.004, P=0.008), BMI (OR: 1.02, P<0.001), and total bilirubin (OR: 1.0001, P=0.025). Conversely, genetic predispositions to cheese intake, coffee intake, cholesterol, LDL, and TG were statistically significantly associated with a decreased risk of gallstones (OR=0.99, P=0.014; OR=0.97, P=0.009; OR=0.99, P=0.006; OR=0.99, P=0.01; and OR=0.99, P<0.001, respectively). In FinnGen, genetic predispositions to BMI and total bilirubin were significantly associated with an increased risk of gallstones. The odds of gallstones would increase per 1-SD increase of genetically estimated BMI (OR: 1.7, P<0.001) and total bilirubin (OR: 1.02, P=0.002). Conversely, genetic predispositions to cheese intake, coffee intake, cholesterol, LDL, and TG were statistically significantly associated with a decreased risk of gallstones (OR=0.23, P=0.006; OR=0.42, P=0.041; OR=0.77, P=0.034; OR=0.88, P=0.008; and OR=0.70, P=0.005, respectively). Conclusion Genetically estimated BMI and total bilirubin levelswere associated with increased risk of gallstones among the two populations whilegenetically estimated cheese intake, coffee intake, and cholesterol, LDL, and TG levels factors were consistently associated with reduced risk of gallstones among the two populations.

Incidence, Risk Factors and Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy

Background and Aim: Gallbladder perforation has been recorded in patients undergoing laparoscopic cholecystectomy and associated with the development of gallstones and bile leakage. The present study investigated the incidence, risk factors, and outcome of gallbladder perforation in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: This prospective study was conducted on 156 patients who underwent laparoscopic cholecystectomy in the department of General Surgery, Federal Government Polyclinic Hospital, Islamabad from January 2021 to July 2022. Gallbladder stone patients with chronic symptoms such as vomiting, recurrent episodes of epigastric, nausea, and hypochondrial pain on right side were included. Acute cholecystitis patients with single or multiple gallstone disease were also enrolled. All the patients were prepared for laparoscopic cholecystectomy and investigations such as blood sugar, liver function test, CBC, blood urea and creatinine, ultrasound of gallbladder, and ECG were done. SPSS version 26 was used for data analysis. Results: Of the total 156 patients, there were 126 (80.8%) females and 30 (19.2%) male. Age-wise distribution of patients were as follows: 66 (42.3%) in 20-35 years, 52 (33.3%) in 36-50 years, and 38 (24.4%) in 51-65 years. The incidence of single gall stone (SGS), multi gallstones (MGS), and acute cholecystitis was 48 (30.8%), 88 (56.4%), and 20 (12.8%) respectively. The overall mean age was 36 years. The incidence of gallbladder perforation was 26.9% (n=42) among all patients. Patients distribution based on gallbladder perforation were as follows: 17 (10.9%) in MGS, 14 (9.0%) in SGS, and 11 (7.1%) in acute cholecystitis cases. Conclusion: The present study found that the prevalence of gallbladder perforation was 26.9% among SGS, MGS, and acute cholecystitis. Majority of GB perforation occurred during gallbladder bed dissection. Acute cholecystitis patients are more prone to GB perforation. GB perforation can be reduced by utilization of harmonic scalpel in laparoscopic cholecystitis. Keywords: Elective laparoscopic cholecystectomy, Gallbladder perforation, Outcomes

PREVALENCE OF POSTOPERATIVE BARIATRIC SURGERY COMPLICATIONS SPECIALLY GALLSTONE

Background:The natural history of gallstone formation after bariatric surgery, the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established.This research is being done to bring awareness to one particular postoperative consequence of bariatric surgery: gallstone development. Methods:This study was retrospective cross-sectional study to achieve the objectives of the study. A cross-sectional study because of the capture information based on data gathered for a specific point in time. Obese population who were surgically managed aby one of the bariatric surgeries. The sampling type was a non-probability convenient sample. Sample size was determined according to 95% confidence level using Epi Info software. Results: Researches filled the questionnaire from 843 participants. Among them, 15.5% had bariatric surgery (n= 131). Age at time of bariatric surgery was more than 25 years among most of participants. Male to female ratio was almost 1:1 among study participants who underwent bariatric surgery. The mean body mass index among study participants was 39.18 + 11.77 kg/m2 while the median BMI was 40.74 kg/m2. This indicates that most of study participants are morbidly obese. The most frequent type of bariatric surgery was gastrectomy operation (n= 101, 77.1%). There were a number of participants who reported having gallstone after the surgery (n= 24, 18.3%). The timing of gallstone formation varied among study participants Conclusion: The incidence of gallstone formation following bariatric surgery was relatively less that other literature. All of study participants who underwent bariatric surgery reported having complications following the surgery.

SHORT AND MID-TERM MEDICAL OUTCOMES OF SLEEVE GASTRECTOMY IN OBESITY IN SULAIMANI CITY. AN ANALYTICAL CROSS-SECTIONAL STUDY

Background &#x0D; The laparoscopic sleeve gastrectomy (LSG) is a frequently performed bariatric procedure. Studies indicate that LSG can facilitate successful and sustainable weight loss.&#x0D; Objectives &#x0D; To examine the short-term (weight reduction) and mid-term (weight maintenance, quality of life, and medical conditions) outcomes following sleeve gastrectomy in Sulaimani.&#x0D; Patients and Methods&#x0D; A cross-sectional study was conducted on 114 participants from both high-quality and Zhyan hospitals in Sulaimani. From Feb 3, 2020, to Jul 22, 2021, data was gathered by evaluating the patient data records of 114 patients. Data included patients’ demographics, preoperative BMI&amp; comorbidities, complications, and weight loss in the first week, second,4th, sixth months, and sixth months. Also, after the sixth month, complications were recorded and analyzed by SPSS software (IBM, version 25), including frequency and percentage, mean, and standard deviation, also obtained for parametric data. The associations between the variables were tested at a P value &lt;0.05.&#x0D; Results&#x0D; The study consists of 114 patients (71.9% female and 28.1% male), with an average age of 34.0 years (range 20- 51 years). The average preoperative BMI and weight were 41.2 kg/m2 and 110.80 kg, respectively. Six months after surgery, the average ± SD of BMI was 32.8 kg/m ± 2 4.5, and the average ± SD of weight was 87.8 kg ±14.4. The prevalence of early postoperative problems (leak, upper GI bleeding, and intraperitoneal hemorrhage) among 114 patients was 0.9% for each complication, while the proportion of early postoperative nausea was 66.7%, and vomiting was 39.5%. Preoperative sleep apnea was 34.2%; after six months of surgery, the percentage was 0%; 19.3% of patients had joint pain; after six months of surgery, the percentage was 0.9%. In addition, 14 out of 114 patients (12.3%) had preoperative Hypertension, and 2 out of 114 patients (1.75%) had diabetes; after six months, 50% of both groups discontinued medical treatment. The incidence of gallstone development six months after surgery was 13.2%. Six months following LSG, 68.4% of individuals had hair loss. &#x0D; Conclusion&#x0D; laparoscopic sleeve gastrectomy can considerably reduce BMI six months following surgery and may help improve or eliminate obesity-related comorbidities such as Hypertension and type 2 diabetes. A laparoscopic sleeve gastrectomy is an effective option for obese adults, resulting in significant weight loss with a low incidence of postoperative complications. LSG could be recommended as a valuable single intervention therapy for patients who typically fail to achieve and obtain real benefits from a structured weight loss program.

Risk Factors of Cholelithiasis: A Literature Review

Cholelithiasis is one of the major health problems around the world. The prevalence of cholelithiasis varies by country. The ethnicity of the people and the geographical location of a country has a huge role in the prevalence of gallstone disease. The etiology of gallstones is not well understood. The most important predisposition factor of gallstone formation is the supersaturation of cholesterol, hypomotility of the gallbladder, and excess bilirubin. Gallstones risk factors are multifactorial. Age, ethnicity, female gender, disease history, and family history are all known to play a role in the development of gallstones. Gallstones have also been linked to smoking, alcohol consumption, body mass index, and cholesterol levels. Sudden weight loss, contraception, and pregnancy in woman also shown to associate with cholelithiasis.

A O01 Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study

Abstract Background Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. Methods This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. Results Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and were excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p &amp;lt; 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months. Conclusions UDCA 500 mg once daily for 12 months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.

Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-analysis.

Patients undergoing gastrectomy for gastric cancer are more likely to develop gallstones than the general population. Prophylactic cholecystectomy remains controversial. Studies from 2000-2022 were systematically searched in the PubMed, EMBASE, and Cochrane Library databases. The search included simultaneous cholecystectomy or risk factors for gallstone formation with gastrectomy alone. Major prognostic factors included complications and mortality, and risk factor analyses included age, sex, TNM stage, gastrectomy type, lymph node dissection, diabetes, and duodenal exclusion. Random effects regression models were used to analyze risk estimates and data were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). There were no significant differences in postoperative morbidity (OR 1.12, 95% CI 0.90-1.39; p=0.33, I2=11%) and mortality (OR 1.23, 95% CI 0.62-2.43; p=0.56, I2=0%) between gastrectomy alone and simultaneous cholecystectomy. Older age (OR 1.48, 95% CI 1.36-1.59; p<0.001, I2=59%), male sex (OR 1.38, 95% CI 1.10-1.71; p=0.004, I2=77%), total gastrectomy (OR 1.50, 95% CI 1.25-1.81; p<0.001, I2=72%), diabetes mellitus (OR 1.38, 95% CI 1.17-1.63; p<0.001, I2=8%), and duodenal exclusion (OR 1.77, 95% CI 1.47-2.15; p<0.001, I2=30%) were risk factors for cholecystolithiasis. Simultaneous cholecystectomy did not increase the incidence of postoperative complications or mortality. Older age, male sex, total gastrectomy, duodenal exclusion, and diabetes were risk factors for gallstone development after gastrectomy.

A Review of Synchronous Findings of Hypothyroidism and Cholelithiasis.

Cholelithiasis is considered to bethe most common biliary pathology. They have been categorized into three types, which are pigment stones, cholesterol stones, and mixed types of stones with varying incidence. The condition may be asymptomatic for significantly long durations and in most cases, the presence of gall stones is an incidental finding. The patients may present with pain in the abdomen in stages of cholecystitis or advanced stages or cases of gall stones causing the obstruction. Gallbladder stones are formed through a very complex procedure with the contribution of numerous factors, where the main initiating step is supposed to be the development of a state wherein there is supersaturation of the bile, which in turn gives rise to accumulation and stasis of the bile and the development of gall stones. One of the factors is said to be the hypothyroid state. Hypothyroidism itself is a significantly common endocrine disorder that affects almost every nucleated cell in the body. There is decreased efficacy of the thyroid gland. The serum T3 and T4 levels might be found on the lower side whereas thyroid-stimulating hormone (TSH) values are found to be high. In some of the cases, though the T3 and T4 levels are maintained within the normal limits, the TSH shows raised values, which are labeled as subclinical hypothyroidism. The state of hypothyroidism may act upon the amount of bile secretion, the flow of bile into the intestines, cholesterol metabolism, and the action of the sphincter of Oddi. Studies have shown results pointing towards the correlation between these two factors. The basicmechanism behind the correlation between cholelithiasis and hypothyroidism is supposed to be due to the action of the hypothyroid state on the functioning of the sphincter of Oddi. The hypothyroid state is supposed to be decreasing the tendency of the sphincter of Oddi to relax, thus causing stasis of the bile, which over time leads to initiation of supersaturation of the bile and formation of gall stones. Both subclinical hypothyroidism and clinical hypothyroidism are found to be significantly common in patients having cholelithiasis. We, in this review article, have taken into consideration various studies which have been performed regarding this topic worldwide. The studies have been performed on individuals who are already diagnosed with either of these diseases and are then screened for the presence of the other disease included in this study. The degree of correlation varies according to the location of the stones and their sizes. Though various studies show varying results to some extent, overall almost all the studies show significant pieces of evidence of the correlation between cholelithiasis and hypothyroidism.

Research progress on the immune microenvironment of the gallbladder in patients with cholesterol gallstones.

Cholesterol gallstones are very common in hepatobiliary surgery and have been studied to a certain extent by doctors worldwide for decades. However, the mechanism of cholesterol gallstone formation is not fully understood, so there is currently no completely effective drug for the treatment and prevention of cholesterol gallstones. The formation and development of cholesterol gallstones are caused by a variety of genetic and environmental factors, among which genetic susceptibility, intestinal microflora disorders, impaired gallbladder motility, and immune disorders are important in the pathogenesis of cholesterol gallstones. This review focuses on recent advances in these mechanisms. We also discuss some new targets that may be effective in the treatment and prevention of cholesterol gallstones, which may be hot areas in the future.

Incidence of Gallbladder Stone Formation After Bariatric Surgery Using Ultrasound Imaging in the Southern Region of Saudi Arabia.

BackgroundBariatric surgery is performed for accomplishing weight loss, which can save patients from diseases associated with morbid obesity. However, rapid weight loss is one of the most important risk factors contributing to the formation of gallbladder stones. The aim of this study is to investigate the prevalence of gallstone formation among patients in the southern region of Saudi Arabia who underwent bariatric surgery and to evaluate the association between several parameters and gallstone development in these patients.MethodsA retrospective study was conducted including 57 patients who did not have gallstones in the preoperative abdominal ultrasound examinations. Demographic data, such as age and gender, were obtained along with other parameters like weight loss after surgery, and time elapsed between the surgery to post-surgery US examination. The findings of the US examinations were collected and analyzed. Data were analyzed to obtain descriptive and inferential statistics. A correlation matrix to investigate the dependence between variables was conducted.ResultsPatients in this study underwent either sleeve gastrectomy (87.7% [n = 50]) or gastric banding procedures (12.3% [n = 7]). The occurrence of cholecystectomy was 46% after sleeve gastrectomy and 71.1% after gastric band procedures. The majority of the patients (57.9%) lost weight after surgery in the range of 20 to 40 kg. The time elapses between the surgery to post-surgery ultrasonography examination varied among patients, where less than one year, one to three years, and three to six years accounted for 47.4%, 43.9%, and 8.8%, respectively. Gallstone formation after the surgery was found in 35 (61.4%) of the total cases. Among patients who developed gallbladder stones after bariatric surgery, 62.9%, 28.4%, and 8.6% were within less than one year, one to three years, and three to six years, respectively. The results suggest a statistically significant correlation betweengallstone formation and​​​ the time elapsed after the surgery (P = 0.008) and the type of bariatric surgery (P = 0.006).ConclusionThe current study found that the overall incidence rate of gallbladder stones after bariatric surgery is 61.4%. The study assumed a possible higher incidence of gallbladder stones following bariatric surgery among the population in the southern region of Saudi Arabia compared to incidence rates reported in the literature. The type of bariatric surgery and the time elapsed after the surgery were found to be of value in predicting the formation of gallstones.

Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery as a Treatment of Obesity

Introduction: Sustained weight loss after gastric bypass is achieved by a combination of gastric restriction and a variable degree of malabsortion and has therefore a greater risk for gallstone development than purely restrictive procedures like adjustable gastric banding. Objectives: The main objective of the study is to analyse the surgical treatment of gallstones in patients undergoing gastric bypass surgery as a treatment of obesity. Material and methods: This randomized control trial was conducted in Jinnah Hospital, Lahore during 2021 to 2022. Patients who underwent bariatric surgery for obesity were included in the study. Those who had cholecystectomy before bariatric surgery, those who underwent concomitant cholecystectomy (CC) during bariatric surgery, those with concomittant gall stoness and those who did not attend their follow-up regularly were excluded from the study. Results: The data was collected from 100 patients and we reviewed records from all patients treated for acute biliary pancreatitis. The average age was 36.43±9.52 years and, the ratio of women/men was 151 (81.6%)/34 (18.4%). Mean BMI was determined as 44.16±5.09. When comorbidities were evaluated, 116 (62.7%) patients had comorbidity, while 69 (37.3%) patients did not. Conclusion: It is concluded that prophylactic and selective management can be safely performed and the only significant difference with patients not submitted to concomitant cholecystectomy is mostly observed in operative times that are higher in those who do undergo cholecystectomy.

Complications lithiasiques chez les patients drépanocytaires

Chronic haemolysis exposes patients with sickle cell disease (SCD) to the development of black pigment gallstones, which can trigger biliary complications. In order to avoid these complications, elective cholecystectomy is recommended in France for all SCD patients with detected gallstones. However, all surgeries, and especially abdominal surgeries, entail an increased risk of vaso-occlusive complications in the peri- and post-operative periods, the most dreadful one being the acute chest syndrome. Preoperative transfusion has been shown in several studies to reduce acute postoperative complications, but exposes the patient to definitive alloimmunization, or even delayed post- transfusion haemolysis, justifying a recent trend towards transfusion sparing. The conditions for avoiding transfusion for a simple and frequent surgery such as cholecystectomy are based on a benefit- risk balance, and must be discussed on a case-by-case basis by the SCD specialist. In particular, it seems fully justified to perform prophylactic preoperative transfusion in patients with a history of recent vaso-occlusive crisis or acute chest syndrome (within 6 months preoperatively), and those operated on in an emergency setting, who are particularly at risk of postoperative events.

Video Caso Clínico: Síndrome del muñón del cístico, resección laparoscópica del remanente

BACKGROUND: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures, which has gradually evolved to become one of the safest surgeries. However, no procedure is without risk; in this context, biliary duct injury (BDI) is the most important intraoperative complication during cholecystectomy. Common bile duct injury reaches a variable incidence between 0.4 to 1.4%, which is associated with significant long-term morbidity, including stenosis and recurrent cholangitis, significant limitations in the life quality of the patient [1]. In order to reduce the incidence of BDI, several alternative procedures can be performed during a difficult cholecystectomy, among which we can list: cholecystostomy, subtotal cholecystectomy and/or conversion to open cholecystectomy. Subtotal cholecystectomy, according to several meta-analyses, minimizes the possibility of bile duct injury, however, it is associated with the persistence or development of symptomatic gallstones in the remnant of the gallbladder or cystic duct; when this occurs, it is necessary to reoperate on symptomatic patients [1,2]. It is estimated that between 5-40% of patients who have previously undergone cholecystectomy, may present episodes of abdominal pain like those that initially motivated the surgical indication, grouped under the term "post-cholecystectomy syndrome" (PCS) [3]. PCS is mainly caused by residual lithiasis, which represents approximately 21.3% of readmissions [4]; other causes of PCS include: stenosis or bile leak, neuroma in the scar tissue, biliary dyskinesia, Oddi sphincter dysfunction. It is also worth highlighting, within the causes, the cystic duct remnant syndrome defined as "presence of a residual cystic duct greater than 1 cm that produces symptoms as a consequence of the lithiasis inside it", with a prevalence of less than 2.5% among patients that underwent cholecystectomy; however, a high index of suspicion will allow us to recognize it in the immediate postoperative period or even several years later [3,4]. The age range of onset of cystic duct remnant syndrome is from 21 to 90 years. The female preponderance of gallstones is the probable reason for greater frequency of the syndrome in this gender. Clinically, the main reason for consultation is abdominal pain in the right hypochondrium and epigastrium, which occurs in 77% of the patients; accompanied by nausea, in 44% of patients; vomiting in 31% and fever in 19% of patients [5]. Magnetic resonance cholangiopancreatography is the non-invasive technique of choice for evaluating the biliary tree, relegating endoscopic retrograde cholangiopancreatography (ERCP) as a strictly therapeutic technique. In addition, ERCP with sphincterotomy and possible placement of a stent to aid drainage of the main bile duct can be performed, along with definitive surgical treatment, by gallbladder and/or cystic remnant resection [3]. This case report details an experience of surgical reintervention in a patient with a remnant gallbladder and cystic duct with lithiasis.

Utilidad del ácido ursodesoxicólico para la prevención de la litiasis vesicular y sus complicaciones en pacientes sometidos a bypass gástrico

Introduction. Rapid weight loss after bariatric surgery is a risk factor for the development of gallstones and its complications. The administration of ursodeoxycholic acid could be a preventive alternative. Aim. To compare the incidence of gallstones in patients treated and not treated with ursodeoxycholic acid and, secondarily, to evaluate the rate of cholecystectomy in each group. Materials and methods. Observational, retrospective cohort study of two non-randomized populations of patients undergoing gastric bypass surgery. The first population was collected retrospectively and the second prospectively and consecutively. Group 1 (without intervention) underwent surgery between January 2016 and December 2018 and did not receive medication, and group 2 (with intervention): operated between May 2019 and October 2020, to whom ursodeoxycholic acid was administered at 600 mg/day for six months. In all cases, abdominal ultrasound was performed at six and twelve months after surgery. Results. In group 1 (n = 73), 21 patients (28.7%) presented an ultrasound finding of gallstones at 6 months, 2 at 12 months (2.73%), for a total of 23 patients (31.5%). In group 2 (n = 32), 4 patients (12.5%) presented a diagnosis of gallstones in the first follow-up period and 1 case in the second, for a total of 5 patients (p = 0.067). Eighteen cholecystectomies were performed due to clinical manifestations related to gallbladder pathology: 17 cases in Group 1 (24.65%) and 1 in Group 2 (3.12%), with a statistically significant difference (p ≤ 0,0435). Conclusion. We have observed a lower incidence of gallstones in the group that received ursodeoxycholic acid, which was clinically relevant, without reaching statistically significant differences. On the other hand, a significant decrease was observed in the number of cholecystectomies one year after bariatric surgery.

Cholesterol crystals activate NLRP3 inflammasomes and promote gallstone formation by increasing mucin secretion

ABSTRACT Cholesterol crystals participate in cholesterol nucleation; however, the role of cholesterol crystals in gallstone development is unknown. Mucin secretion contributes to increased size of gallstones. Cholesterol crystals activate inflammasomes and participate in many sterile inflammation related human diseases. We investigated the role of cholesterol crystals and mucins in sterile inflammation and gallstone enlargement. We found that expression of mucin 5AC (MUC5AC), NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) and interleukin-1b (IL-1b) was increased significantly in tissues adjacent to gallstones. Experiments in vitro showed that cholesterol crystals promote MUC5AC secretion; they also increase expression of NLRP3, NLR family CARD domain-containing 4 (NLRC4), apoptosis-associated speck-like protein containing caspase recruitment domain (ASC), and cleaved caspase-1 in biliary epithelial cells. Inhibition of Inflammasomes by NLRP3, ASC or caspase-1 small interfering RNAs reduced MUC5AC secretion. Also, the IL-1 receptor antagonist, IL1RA, and caspase-1 inhibitor, Ac-YVAD, both inhibited MUC5AC secretion induced by cholesterol crystals. We found that inflammasome activation participates in cholesterol crystal induced mucin secretion and gallstone development.

Gall Bladder Stones Formation in Patients with Breast Cancer on Tamoxifen Therapy in Iraqi Female

BACKGROUND: Tamoxifen has an estrogenic effect on the liver, lead to increase the danger of gallstone development. AIM: This study aimed to determine the prevalence of gall bladder stones formation during tamoxifen therapy. METHODS: A prospective casecontrol study enrolled 14 premenopausal and 36 postmenopausal females. The gall bladder condition was assessed by abdominal ultrasound using “Alpinion Portable Color Doppler E-CUBE,” in addition, clinical parameters collected as age and weight of patients. RESULTS: Approximately, 14 (28%) of women were premenopausal their age ranged from (25 to 44) years, and 36 (72%) postmenopausal females their age was between (45 and 78) years. The duration of tamoxifen therapy was (range &gt;–72) months, with 33 control cases. All cases examined by pelvic ultrasound, only 11 (22%) showed gall bladder stones. The gall bladder stones were diagnosed, in 4 of premenopausal, whereas seven patients were postmenopausal. There is a significant relation with gall bladder stones with increase body weight during therapy. CONCLUSION: There is a significant correlation between gall bladder stones formation and tamoxifen therapy. Postmenopausal women have a higher risk of developing gall bladder stones formation.

Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study.

Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500mg UDCA daily for 12months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12months. UDCA 500mg once daily for 12months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.

Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program.

ABSTRACT.Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a “Typhoid Epidemiologic SWAT Team” to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.

Percutaneous Transhepatic Cholecystolithotomy by Holmium Laser for Non-high-Risk Patients with Symptomatic Gallbladder Stones.

Background:The development of gallstones, also known as cholelithiasis, is one of the most common diseases associated with the gastrointestinal tract. In developing countries 10% to 15% of men and >25% of women experience gallstones.Objective:The aim of the study was to evaluate the outcomes following percutaneous transhepatic cholecystolithotomy by holmium laser in non–high-risk patients with symptomatic gallbladder stones.Methods:This was an intervention study without control and with longitudinal follow-up. Subjects included patients who had only gallbladder stones, a normal gallbladder contractility index, and required a conservative treatment.Results:The study included 44 patients (20 men, 24 women), with a mean age of 41.5 ± 13.4 years. The success rate was 97.7%, and only 1 of 44 patients required follow-up laparoscopic cholecystectomy. Gallstones were successfully removed from 43 of 44 patients (97.7%). The complication rate was 13.6% (6/44 patients), and only minor complications were reported for 5 of the 6 patients with complications. In 34 of 43 patients, follow-up examinations were performed after 1 and 6 months. The gallstone recurrence rate at six-month follow-up was 11.8%, and a collapsed gallbladder was detected in 1 of 34 patients, with the remaining 33 patients retaining normal gallbladder contractility indices (>40%).Conclusion:Percutaneous transhepatic cholecystolithotomy by holmium laser has a high gallstone removal rate (97.7%); however, recurrence remains a major problem. The complication rate was about 13.6%, most of which were minor complications. Cases associated with treatment failure or serious complications should be detected and treated promptly.

Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass.

Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.