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Lee SY, Jang SI, Cho JH, Do MY, Lee SY, Choi A, Lee HS, Yang J, Lee DK. Gallstone Dissolution Effects of Combination Therapy with n-3 Polyunsaturated Fatty Acids and Ursodeoxycholic Acid: A Randomized, Prospective, Preliminary Clinical Trial. Gut Liver 2024; 18:1069-1079. [PMID: 38712398 PMCID: PMC11565012 DOI: 10.5009/gnl230494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : Ursodeoxycholic acid (UDCA) is the only well-established and widely used agent for dissolving gallstones. Epidemiological and animal studies have suggested potential therapeutic benefits of n-3 polyunsaturated fatty acids (PUFA) for dissolving cholesterol gallstones. We evaluated whether adding PUFA to UDCA improves gallstone dissolution in patients with cholesterol gallstones. Methods : This randomized, prospective, preliminary clinical trial compared the efficacy and safety of UDCA plus PUFA combination therapy (combination group) with those of UDCA monotherapy (monotherapy group). The inclusion criteria were a gallstone diameter ≤15 mm on ultrasonography, radiolucent stones on plain X-ray, and no to mild symptoms. Gallstone dissolution rates, response rates, and adverse events were evaluated. Results : Of the 59 screened patients, 45 patients completed treatment (24 and 21 in the monotherapy and combination groups, respectively). The gallstone dissolution rate tended to be higher in the combination group than in the monotherapy group (45.7% vs 9.9%, p=0.070). The radiological response rate was also significantly higher in the combination group (90.5% vs 41.7%, p=0.007). In both groups, dissolution and response rates were higher in patients with gallbladder sludge than in those with distinct stones. Four adverse events (two in each group) were observed, none of which were study drug-related or led to drug discontinuation. The incidence of these adverse events was similar in both groups (combination vs monotherapy: 9.5% vs 8.3%, p=0.890). Conclusions : UDCA plus PUFA therapy dissolves cholesterol gallstones more effectively than UDCA monotherapy, without significant complications. Further prospective, large-scale studies of this combination therapy are warranted.
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Affiliation(s)
- See Young Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Young Do
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Yeon Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Arong Choi
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Motta RV, Saffioti F, Mavroeidis VK. Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease. World J Gastroenterol 2024; 30:1836-1850. [PMID: 38659478 PMCID: PMC11036492 DOI: 10.3748/wjg.v30.i13.1836] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/03/2024] Open
Abstract
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.
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Affiliation(s)
- Rodrigo V. Motta
- Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Francesca Saffioti
- Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London NW3 2QG, United Kingdom
| | - Vasileios K Mavroeidis
- Department of HPB Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
- Department of Transplant Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
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Lin YC, Chen IC, Chen YJ, Lin CT, Chang JC, Wang TJ, Chen YM, Lin CH. Association between HNF4A rs1800961 polymorphisms and gallstones in a Taiwanese population. J Gastroenterol Hepatol 2024; 39:305-311. [PMID: 38058101 DOI: 10.1111/jgh.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM A large genetic effect of a novel gallstone-associated genetic variant, the hepatocyte nuclear factor 4α (HNF4A) rs1800961 polymorphism, has been identified through recent genome-wide association studies. However, this effect has not been validated in Asian populations. We investigated the association between the rs1800961 variant and gallstones among a Taiwanese population. METHODS A total of 20 405 participants aged between 30 and 70 years voluntarily enrolled in the Taiwan Biobank. Self-report questionnaires, physical examinations, biochemical tests, and genotyping were used for analysis. The association of the HNF4A rs1800961 variant and other metabolic risks with gallstone disease was analyzed using multiple logistic regression models. RESULTS The minor T allele of HNF4A rs1800961 was associated with an increased risk of gallstone, and the association remained significant even after adjustment for other risk factors including age, body mass index (BMI), diabetes, hyperlipidemia, hypertension, and cigarette smoking (adjusted odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.31 to 2.75) in male participants. When further stratified by BMI and age, the lithogenic effect was the most significant in male participants with obesity (adjusted OR = 3.55, 95% CI = 1.92 to 6.56) and who were younger (adjusted OR = 2.45, 95% CI = 1.49 to 4.04). CONCLUSION The novel gallstone-associated HNF4A rs1800961 variant was associated with the risk of gallstone in the Taiwanese men. Screening for the rs1800961 polymorphism may be particularly useful in assessing the risk of gallstone formation in younger or obese men.
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Affiliation(s)
- Ying-Cheng Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Ju Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui-Chun Chang
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Jung Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Precision Medicine Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Ker CG. Hepatobiliary surgery in Taiwan: The past, present, and future. Part I; biliary surgery. FORMOSAN JOURNAL OF SURGERY 2024; 57:1-10. [DOI: 10.1097/fs9.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2024] Open
Abstract
Abstract
In Taiwan, most surgical services were mainly provided by Japanese or Western surgeons before World War II. Tsuchiya Kunita first reported surgical treatment of gallstone diseases in 1915 in Taiwan. After World War II, experienced Japanese surgeons returned to Japan, and well-trained surgeons moved to Taiwan from different hospitals in Mainland China after 1949. In 1954, Liao had reported surgical gallstone diseases treated by cholecytostomy, cholecystectomy, and cholecystogastrostomy or cholecystoduodenostomy from National Taiwan University Hospital (Formos J Surg. 1954;53:833–4). By using of operative cholangiography, diagnosis and removal of intrahepatic stones could be done through choledochostomy reported first by Lee HC from National Defense Medical Center in 1966 and 1968 (Chin Med J ROC. 1966;13:301–8; Chin Med J ROC. 1968;15:124–34). Wei from the National Taiwan University Hospital reported the first left hepatectomy for treating hepatolithiasis on one patient among his series in 1971 (Formos J Surg. 1971;4:178–96). Treatments of hepatolithiasis were well analyzed by Wen and Lee from Triservice General Hospital and Veterans General Hospital in 1972 (Ann Surg. 1972;175:166–77). Hwang was the first to use choledochofiberscope for removing retained stones since 1974 reported from Show Chwan Memorial Hospital in 1978 (Am J Surg. 1978;139:860–4). The first laparoscopic cholecystectomy was performed by Huang from Taipei Cathay General Hospital in 1990 in Taiwan (J Formos Med Assoc. 1991;90:893–9). Nowadays, Taiwan hepatobiliary surgeons were extensively using either laparoscopic or robotic surgery for treatment of hepatobiliary diseases.
In conclusion, we should never forget the great contributions from many clinics in rural villages hosted by Christian or Catholicism organizations in Taiwan hundred years ago. We should express our appreciations to the history of the evolutions of biliary surgical skills. In Taiwan, a great surgeon today is always standing on the shoulders of our ancient giants, our surgical teachers.
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Ceci L, Han Y, Krutsinger K, Baiocchi L, Wu N, Kundu D, Kyritsi K, Zhou T, Gaudio E, Francis H, Alpini G, Kennedy L. Gallstone and Gallbladder Disease: Biliary Tract and Cholangiopathies. Compr Physiol 2023; 13:4909-4943. [PMID: 37358507 DOI: 10.1002/cphy.c220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Cholestatic liver diseases are named primarily due to the blockage of bile flow and buildup of bile acids in the liver. Cholestasis can occur in cholangiopathies, fatty liver diseases, and during COVID-19 infection. Most literature evaluates damage occurring to the intrahepatic biliary tree during cholestasis; however, there may be associations between liver damage and gallbladder damage. Gallbladder damage can manifest as acute or chronic inflammation, perforation, polyps, cancer, and most commonly gallstones. Considering the gallbladder is an extension of the intrahepatic biliary network, and both tissues are lined by biliary epithelial cells that share common mechanisms and properties, it is worth further evaluation to understand the association between bile duct and gallbladder damage. In this comprehensive article, we discuss background information of the biliary tree and gallbladder, from function, damage, and therapeutic approaches. We then discuss published findings that identify gallbladder disorders in various liver diseases. Lastly, we provide the clinical aspect of gallbladder disorders in liver diseases and ways to enhance diagnostic and therapeutic approaches for congruent diagnosis. © 2023 American Physiological Society. Compr Physiol 13:4909-4943, 2023.
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Affiliation(s)
- Ludovica Ceci
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Yuyan Han
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Kelsey Krutsinger
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | | | - Nan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Debjyoti Kundu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Konstantina Kyritsi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tianhao Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Heather Francis
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Gianfranco Alpini
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Lindsey Kennedy
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Chou T, Lin C, Chen L, Hu C, Chang J, Yen C, Chen S, Liu C, Chien C. Waist-to-height ratio for the prediction of gallstone disease among different obesity indicators. Obes Sci Pract 2023; 9:30-41. [PMID: 36789027 PMCID: PMC9913192 DOI: 10.1002/osp4.650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background Factors of metabolic syndrome such as obesity are well-known risk factors for gallstone disease (GSD). There are different indicators of obesity, including weight, body mass index, waist circumference, and waist-to-height ratio. The predictive ability of different obesity indicators for GSD remains unclear. Objective To explore the most efficient predictor of GSD among the different anthropometric indicators of obesity. Methods This population-based cross-sectional study included 2263 participants who completed a questionnaire detailing their demographics, medical history, and lifestyle between 2014 and 2017 in Taiwan. Blood samples were collected and physical examinations, including anthropometric measurements, were performed. Gallstone disease was ascertained using ultrasonography. Multivariate analyses were performed to identify independent risk factors for GSD. Results The overall prevalence of GSD was 8.8%. According to the multivariate analysis, individuals with a waist-to-height ratio ≥0.5 (odds ratio|odds ratios (OR) = 1.65, 95% confidence interval (CI) = 1.10-2.48, p = 0.017) had an increased risk of GSD. Diabetes was the main risk factor for GSD in men (OR = 2.06, 95% CI = 1.17-3.65, p = 0.013). Among women, waist-to-height ratio >0.5 (OR = 1.76, 95% CI = 1.03-3.02, p = 0.040) and current hormone drug use (OR = 2.73, 95% CI = 1.09-6.84, p = 0.033) were significant risk factors for gallstones. Conclusion GSD was independently associated with central obesity and exogenous hormone intake in women. Among the anthropometric indicators used to assess central obesity, waist-to-height ratio was the most accurate predictor of GSD.
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Affiliation(s)
- Tien‐Shin Chou
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Chih‐Lang Lin
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Liver Research UnitKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Li‐Wei Chen
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Liver Research UnitKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Ching‐Chih Hu
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Liver Research UnitKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Jia‐Jang Chang
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Cho‐Li Yen
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Shuo‐Wei Chen
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Ching‐Jung Liu
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
| | - Cheng‐Hung Chien
- Division of GastroenterologyDepartment of Internal MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Liver Research UnitKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan, ROC
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Watanabe ALC, de Freitas ACT, Stadnik L, Coelho JCU. Hepatectomy and intrahepatic hepaticocutaneous jejunostomy for bilateral primary hepatolithiasis: Case report. Int J Surg Case Rep 2020; 72:69-71. [PMID: 32512411 PMCID: PMC7281362 DOI: 10.1016/j.ijscr.2020.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Primary hepatolithiasis is a rare disease in western countries. Primary intrahepatic stones are associated with repeated attacks of acute cholangitis. Primary bilateral hepatolithiasis can be managed with partial hepatectomy with an intrahepatic hepaticocutaneous jejunostomy. Introduction Primary hepatolithiasis is a rare disease in western countries and it is associated with repeated attacks of acute cholangitis. Without proper treatment, hepatolithiasis can lead to progressive biliary strictures and secondary biliary cirrhosis. Presentation of case A 40 years old male was admitted due to recurrent cholangitis during the last 18 years. Bilateral primary hepatolithiasis was diagnosed and treated by left hepatectomy with an intrahepatic hepaticocutaneous jejunostomy. There were no postoperative complications and the patient was discharged after 7 days. Discussion The management of patients with primary hepatolithiasis remains a challenging task due to the high incidence of residual and recurrent stones after treatment. Conclusion Primary bilateral hepatolithiasis is a complex disease that can be managed with partial hepatectomy with an intrahepatic hepaticocutaneous jejunostomy.
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Affiliation(s)
- André Luís Conde Watanabe
- Division of Gastrointestinal Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
| | | | - Lucinei Stadnik
- Division of Gastrointestinal Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Júlio Cezar Uili Coelho
- Division of Gastrointestinal Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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Lou J, Hu Q, Ma T, Chen W, Wang J, Pankaj P. A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary stricture. BMC Gastroenterol 2019; 19:172. [PMID: 31675911 PMCID: PMC6824045 DOI: 10.1186/s12876-019-1093-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hepatolithiasis, featuring high incidence, severe symptoms, and common recurrence, poses a heavy disease burden. Endoscopic management provides an opportunity to cure hepatolithiasis, but fails to properly resolve biliary stricture without additional interventional techniques. An innovative approach towards endoscopic management of biliary stricture is required. METHODS Holmium laser ablation was applied to biliary strictures via endoscopic access. Patients' demographic, operative, and follow-up data after receiving holmium laser ablation were retrospectively collected for analysis. RESULTS A total of 15 patients (4 males and 11 females) underwent stricture ablation by holmium laser via cholangioscopy. All the patients successfully received holmium laser ablation, indicating a technical success rate of 100%. No postoperative mortality or no major perioperative complication was observed. During the follow-up period, the recurrence-free rate was 73% at 2 years and 67% at 5 years. CONCLUSIONS We successfully developed a novel technique of biliary stricture removal by cholangioscopic holmium laser ablation with satisfying clinical outcomes.
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Affiliation(s)
- Jianying Lou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, Zhejiang, China.
| | - Qida Hu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310003, Zhejiang, China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310003, Zhejiang, China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310003, Zhejiang, China
| | - Ji Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310003, Zhejiang, China
| | - Prasoon Pankaj
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, Zhejiang, China
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Jang SI, Fang S, Kim KP, Ko Y, Kim H, Oh J, Hong GY, Lee SY, Kim JM, Noh I, Lee DK. Combination treatment with n-3 polyunsaturated fatty acids and ursodeoxycholic acid dissolves cholesterol gallstones in mice. Sci Rep 2019; 9:12740. [PMID: 31484954 PMCID: PMC6726655 DOI: 10.1038/s41598-019-49095-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/19/2019] [Indexed: 01/11/2023] Open
Abstract
The increasing prevalence of cholesterol gallstone disease places an economic burden on the healthcare system. To identify novel therapeutics, we assessed the effects of n-3 polyunsaturated fatty acids (PUFA) in combination with UDCA in a mouse model of cholesterol gallstones. Gallstone dissolution, gallbladder wall thickness, mucin gene expression in the gallbladder, and levels of phospholipids, cholesterol, and bile acids in bile and serum were analysed. RNA was extracted from the liver for mRNA sequencing and gene expression profiling. Combination treatment resulted in greater gallstone dissolution compared with the control group, and PUFA and combination treatments reduced the thickness of the gallbladder wall. Expression levels of mucin genes were significantly lower in the UDCA, PUFA, and combination groups. Transcriptome analyses revealed that combination treatment modulated hepatic lipid metabolism. The PUFA and combination groups showed elevated bile phospholipid and bile acid levels and a lower cholesterol saturation index. Combination treatment with PUFA and UDCA dissolves cholesterol gallstones in mice by decreasing mucin production, increasing levels of phospholipids and bile acids in bile, and decreasing cholesterol saturation. Further studies of the therapeutic effects of combination PUFA and UDCA treatment in patients with cholesterol gallstones are warranted.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoon Fang
- Severance Biomedical Science Institute, BK21 Plus Project for Medical Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Pyo Kim
- Department of Applied Chemistry College of Applied Sciences, Kyung Hee University, Yong-in City, Republic of Korea
| | - Younhee Ko
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Hyoseon Kim
- Department of Applied Chemistry College of Applied Sciences, Kyung Hee University, Yong-in City, Republic of Korea
| | - Jieun Oh
- Department of Applied Chemistry College of Applied Sciences, Kyung Hee University, Yong-in City, Republic of Korea
| | - Ga Young Hong
- Department of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Su Yeon Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Ilkoo Noh
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Shu J, Wang XJ, Li JW, Bie P, Chen J, Zheng SG. Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis. Surg Endosc 2019; 33:2539-2547. [PMID: 30350102 DOI: 10.1007/s00464-018-6547-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The indication for laparoscopic treatment of hepatolithiasis is early-stage regional hepatolithiasis. Open surgery (OS) is the traditional treatment for complex hepatolithiasis. Robotic-assisted laparoscopic surgery (RLS) overcomes the limitations of the traditional laparoscopic approach in terms of the visual field, instruments, and operational flexibility. RLS is thus theoretically indicated for the treatment of complicated hepatolithiasis. This study aimed to evaluate the safety, efficacy, and feasibility of RLS for the treatment of complicated hepatolithiasis. METHODS From October 2010 to August 2017, 26 consecutive patients who underwent RLS and 287 consecutive patients who underwent OS for the treatment of complicated hepatolithiasis at our center were included in this study. We performed a propensity score matching (PSM) analysis between patients who underwent RLS and patients who underwent OS at a ratio of 1:2. Twenty-six patients were included in the RLS group, and 52 patients were included in the OS group. RESULTS The groups exhibited no differences with respect to age, sex, location of stones, liver function, history of previous surgery, or Child-Pugh classification. There were no differences in the postoperative complication rates (46.2% vs. 63.5%, p = 0.145), intraoperative stone clearance rates (96.2% vs. 90.4%, p = 1.000), or final stone clearance rates (100% vs. 98.1%, p = 0.652) between the two groups. The RLS group had less blood loss (315.38 ± 237.81 vs. 542.88 ± 518.70 ml, p = 0.037), a lower transfusion rate (15.4% vs. 46.2%, p = 0.008), shorter oral intake times (3.50 ± 1.30 vs. 5.88 ± 4.00 days, p = 0.004), and shorter postoperative hospital stays (13.54 ± 6.54 vs. 17.81 ± 7.49 days, p = 0.016) than the OS group. At a median follow-up of 48 months (range 7-90 months), there were no differences in stone recurrence rate (3.8% vs. 13.5%, p = 0.356) or recurrent cholangitis rate (3.8% vs. 3.8%, p = 1.000) between RLS and OS patients. CONCLUSION RLS for complicated hepatolithiasis is safe and feasible with advantages over OS in terms of intraoperative blood loss, transfusion rate, duration of hospital stays, and postoperative recovery.
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Affiliation(s)
- Jie Shu
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Xiao-Jun Wang
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian-Wei Li
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Ping Bie
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian Chen
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Shu-Guo Zheng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.
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Abstract
OBJECTIVE To investigate the relation of Hashimoto's thyroiditis (HT) to cholelithiasis and cholecystectomy in a retrospective population-based study. SETTING Cohort study. PARTICIPANTS We identified 1268 patients aged ≥20 years with HT between 2000 and 2010 as the study cohort. PRIMARY AND SECONDARY OUTCOME MEASURES Patients without HT were randomly selected from a database and propensity-matched with the study cohort at a 1:4 ratio according to age, sex, comorbidities and year of the index date to measure the incidence of cholelithiasis and cholecystectomy. RESULTS The cumulative incidence of cholelithiasis was higher in the HT cohort than that in the non-HT cohort (log-rank test, p<0.001), with a 1.91-fold higher risk of choleithiasis (95% CI 1.58 to 2.33) after adjustment for comorbidities. The age-specific relative risk of cholelithiasis in the HT cohort was higher than that in the non-HT cohort for patients aged ≥50 years (adjusted HR (aHR)=2.59, 95% CI 1.33 to 5.03). The sex-specific relative risk of cholelithiasis in the HT cohort was higher than that in the non-HT cohort for women (aHR=1.99, 95% CI 1.63 to 2.44). Compared with those in the non-HT cohort, patients with HT without (aHR=1.95, 95% CI 1.53 to 2.49) and with (aHR=1.94, 95% CI 1.51 to 2.49) thyroxine treatment were associated with a higher risk of cholelithiasis. Compared with those in the non-HT cohort, patients with HT had a higher risk of cholecystectomy (aHR=1.28, 95% CI 1.02 to 1.61). CONCLUSIONS Inability to obtain information on several potential confounding factors and misclassification of important covariates are the major limitations of the study. Our study indicates HT per se was associated with the development of cholelithiasis, which has been validated by the association between cholecystectomy and HT. Surveys and health education on cholelithiasis in women aged ≥50 years with HT should be considered by clinicians, and further prospective research should be done on this topic.
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Affiliation(s)
- Chien-Hua Chen
- Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan
- Digestive Disease Center, Changbing Show-Chwan Memorial Hospital, Changhua County, Taiwan
- Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan
- Chung Chou University of Science and Technology, Changhua County, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Abstract
Hepatolithiasis is highly prevalent in Asia but rare in Western countries. However, the incidence of hepatolithiasis may be increasing in Western countries due to the increased rate of immigration from areas where hepatolithiasis is prevalent. There are many non-surgical treatments for hepatolithiasis, but surgical management remains the best curative treatment for some cases of hepatolithiasis. Surgical treatments can remove biliary stones and relieve stricture of the bile ducts. This review describes the indications for and the outcomes of surgical treatment of hepatolithiasis, including liver resection and liver transplantation.
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Affiliation(s)
- Chuan Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tianfu Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
- Address correspondence to: Dr. Tianfu Wen, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China. E-mail:
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Ma RH, Luo XB, Wang XF, Qiao T, Huang HY, Zhong HQ. A comparative study of mud-like and coralliform calcium carbonate gallbladder stones. Microsc Res Tech 2017; 80:722-730. [PMID: 28245082 DOI: 10.1002/jemt.22857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/13/2017] [Accepted: 02/10/2017] [Indexed: 01/06/2023]
Abstract
To gain insight to underlying mechanism of the formation of calcium carbonate (CaCO3 ) gallbladder stones, we did comparative study of stones with mud appearance and those with coralliform appearance. A total of 93 gallbladder stones with mud appearance and 50 stones with coralliform appearance were analyzed. The appearance, color, texture, and the detection of Clonorchis sinensis eggs by microscopic examination were compared between the two groups. Then, the material compositions of stones were analyzed using Fourier Transform Infrared spectroscopy and the spectrogram characteristics were compared. Moreover, microstructure characteristics of the two kinds of stones were observed and compared with Scanning Electron Microscopy. Mud-like gallbladder stones were mainly earthy yellow or brown with brittle or soft texture, while coralliform stones were mainly black with extremely hard texture, the differences between the two groups was significant (p < .05). The analytic results of FTIR spectroscopy showed that 95.7% (89/93) of the mud-like gallbladder stones were CaCO3 stones, and mainly aragonite; while all of the coralliform stones were CaCO3 stones, and mainly calcite (p < .05). Meanwhile, microscopic examination indicated that the detection rate of Clonorchis sinensis eggs in mud-like CaCO3 stones was lower than that in coralliform CaCO3 stones (p < .05), and that in aragonite CaCO3 stones was lower than that in calcite CaCO3 stones(p < .05). Mud-like CaCO3 stones mainly happened to patients with cystic duct obstruction. Clonorchis sinensis infection was mainly associated with coralliform (calcite) CaCO3 stones. Cystic duct obstruction was mainly associated with mud-like (aragonite) CaCO3 stones.
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Affiliation(s)
- Rui-Hong Ma
- Department of Clinical Laboratory, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
| | - Xiao-Bing Luo
- Department of Clinical Laboratory, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
| | - Xiao-Feng Wang
- Department of General Surgery, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
| | - Tie Qiao
- Department of General Surgery, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
| | - Hai-Yi Huang
- Department of Ultrasonics, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
| | - Hai-Qiang Zhong
- Department of Clinical Laboratory, The Sixth People's Hospital of Nansha, Guangzhou, 511470, People's Republic of China
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Lv S, Fang Z, Wang A, Yang J, Zhang W. Choledochoscopic Holmium Laser Lithotripsy for Difficult Bile Duct Stones. J Laparoendosc Adv Surg Tech A 2017; 27:24-27. [PMID: 28048950 DOI: 10.1089/lap.2016.0289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of choledochoscopic holmium laser lithotripsy as a means of removing resistant extrahepatic and intrahepatic bile duct stones. METHODS Clinical data on 28 patients who had undergone choledochoscopic holmium laser lithotripsy were analyzed. RESULTS Complete stone clearance was obtained in 24 patients; small numbers of residual stones in the left or right hepatic duct were found in 4 patients. No severe complications such as hemobilia and bile duct injuries occurred. CONCLUSION Choledochoscopic holmium laser lithotripsy is a simple, safe, and effective treatment method for patients with resistant bile duct stones.
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Affiliation(s)
- Shangdong Lv
- Department of Hepatobiliary Surgery, Taizhou Hospital affiliated to Wenzhou Medical University , Taizhou, China
| | - Zheping Fang
- Department of Hepatobiliary Surgery, Taizhou Hospital affiliated to Wenzhou Medical University , Taizhou, China
| | - Aidong Wang
- Department of Hepatobiliary Surgery, Taizhou Hospital affiliated to Wenzhou Medical University , Taizhou, China
| | - Jian Yang
- Department of Hepatobiliary Surgery, Taizhou Hospital affiliated to Wenzhou Medical University , Taizhou, China
| | - Wenlong Zhang
- Department of Hepatobiliary Surgery, Taizhou Hospital affiliated to Wenzhou Medical University , Taizhou, China
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Endo I, Matsuyama R, Mori R, Shimada H. Intrahepatic stones. BLUMGART'S SURGERY OF THE LIVER, BILIARY TRACT AND PANCREAS, 2-VOLUME SET 2017:642-655.e3. [DOI: 10.1016/b978-0-323-34062-5.00039-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Comparison Between Percutaneous Transhepatic Rigid Cholangioscopic Lithotripsy and Conventional Percutaneous Transhepatic Cholangioscopic Surgery for Hepatolithiasis Treatment. Surg Laparosc Endosc Percutan Tech 2016; 26:54-9. [PMID: 26679679 PMCID: PMC4736300 DOI: 10.1097/sle.0000000000000222] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Percutaneous transhepatic cholangioscopy (PTCS) is one option for treating hepatolithiasis without surgical resection. This approach can use conventional biliary drainage methods over a long period, but a shorter procedure needs to be evolved. Objective: To evaluate the short-term and the long-term therapeutic outcomes of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in comparison with conventional PTCS. Methods: In this retrospective study, 118 patients with hepatolithiasis were enrolled who underwent treatment in our hospital between March 2007 and July 2014. About 67 of them received PTCSL and the remaining 51 patients received conventional PTCS. Preoperative data, surgical operation-related records, the postoperative therapeutic effect, and the long-term hepatolithiasis recurrence rate were collected for comparison between the 2 groups. Results: The age, sex, and surgical history were similar between the 2 groups, but there was a significant difference in the Child-Pugh score, with more grade 3 patients in the PTCS group (P=0.002). However, the operation time, intraoperative blood infusion, and the blood loss were similar between the 2 groups. The final clearance ratio of calculus in the PTCSL group was significantly better than in the PTCS group after multivariate analysis (P=0.021; OR=0.201; 95% CI, 0.051-0.785). Calculus recurrence was 9% (PTCSL) and 22% (PTCS). The postoperative hospital stay was significantly shorter in the PTCSL group (P=0.001; OR=1.337; 95% CI, 1.132-1.58). Conclusions: PTCSL was a satisfactory therapeutic option for hepatolithiasis treatment, with less operation time and a superior long-term therapeutic effect compared with conventional PTCS.
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Shi S, Xia W, Guo H, Kong H, Zheng S. Unique characteristics of pyogenic liver abscesses of biliary origin. Surgery 2016; 159:1316-24. [DOI: 10.1016/j.surg.2015.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 02/08/2023]
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Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE, Park JJ, Byun KS, Bak YT. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol 2015; 21:13418-13431. [PMID: 26730152 PMCID: PMC4690170 DOI: 10.3748/wjg.v21.i48.13418] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023] Open
Abstract
Although the incidence of hepatolithiasis is decreasing as the pattern of gallstone disease changes in Asia, the prevalence of hepatolithiasis is persistently high, especially in Far Eastern countries. Hepatolithiasis is an established risk factor for cholangiocarcinoma (CCA), and chronic proliferative inflammation may be involved in biliary carcinogenesis and in inducing the upregulation of cell-proliferating factors. With the use of advanced imaging modalities, there has been much improvement in the management of hepatolithiasis and the diagnosis of hepatolithiasis-associated CCA (HL-CCA). However, there are many problems in managing the strictures in hepatolithiasis and differentiating them from infiltrating types of CCA. Surgical resection is recommended in cases of single lobe hepatolithiasis with atrophy, uncontrolled stricture, symptom duration of more than 10 years, and long history of biliary-enteric anastomosis. Even after resection, patients should be followed with caution for development of HL-CCA, because HL-CCA is an independent prognostic factor for survival. It is not yet clear whether hepatic resection can reduce the occurrence of subsequent HL-CCA. Furthermore, there are no consistent findings regarding prediction of subsequent HL-CCA in patients with hepatolithiasis. In the management of hepatolithiasis, important factors are the reduction of recurrence of cholangitis and suspicion of unrecognized HL-CCA.
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Metwally O, Man K. The role of endoscopy in the management of recurrent pyogenic cholangitis: a review. J Community Hosp Intern Med Perspect 2015; 5:27858. [PMID: 26333855 PMCID: PMC4558289 DOI: 10.3402/jchimp.v5.27858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/19/2015] [Accepted: 05/28/2015] [Indexed: 12/30/2022] Open
Abstract
Recurrent pyogenic cholangitis (RPC) is a clinical syndrome characterized by repeated episodes of suppurative cholangitis due to hepatolithiasis and extrahepatic stones in the biliary ducts. It is now recognized as a distinct syndrome with a different natural history and pathoetiology than spontaneously occurring liver abscesses. Most commonly seen in East Asian populations, this syndrome is growing increasingly common in Western Nations due to migration patterns. The exact pathogenesis of RPC remains elusive; although colonization of the biliary tract with particular enteric bacterial species, in combination with possible dietary factors, has been attributed as causative factors. Hepatobiliary surgery, in particular segmental hepatectomy, is often described as the definitive treatment of choice for RPC. The exact role of endoscopic intervention has been less clearly described in the literature. This review focuses on the management of RPC while highlighting situations in which endoscopic retrograde cholangiopancreatography may be preferred over surgery as an initial or salvage therapeutic measure.
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Affiliation(s)
| | - Kevin Man
- Division of Gastroenterology, St. Mary's Medical Center, San Francisco, CA, USA
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Hung SH, Lin HC, Su CH, Chung SD. Association of sialolithiasis with cholelithiasis: A population-based study. Head Neck 2015; 38:560-3. [DOI: 10.1002/hed.23926] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 01/06/2023] Open
Affiliation(s)
- Shih-Han Hung
- Department of Otolaryngology; Taipei Medical University Hospital; Taipei Taiwan
- Department of Otolaryngology; School of Medicine; Taipei Medical University; Taipei Taiwan
| | - Herng-Ching Lin
- Sleep Research Center; Taipei Medical University; Taipei Taiwan
| | - Chin-Hui Su
- Department of Otolaryngology; School of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Otorhinolaryngology; Mackay Memorial Hospital; Taipei Taiwan
| | - Shiu-Dong Chung
- Sleep Research Center; Taipei Medical University; Taipei Taiwan
- Division of Urology, Department of Surgery; Far Eastern Memorial Hospital; New Taipei City Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
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Bergquist A, von Seth E. Epidemiology of cholangiocarcinoma. Best Pract Res Clin Gastroenterol 2015; 29:221-32. [PMID: 25966423 DOI: 10.1016/j.bpg.2015.02.003] [Citation(s) in RCA: 288] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/07/2015] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma (CCA) is a cancer arising from the intra- or extrahepatic bile ducts and mainly characterized by its late diagnosis and fatal outcome. CCA is the second most common primary liver tumour and accounts for approximately 10-15% of all hepatobiliary malignancies. The development of CCA is linked to a wide spectrum of conditions causing biliary inflammation, cholestasis and inflammation of the liver. The geographic diversity of risk factors is reflected in considerable differences in incidence worldwide. Although data are not consistent, incidence seems to be rising in the Western World. Given the limited opportunities of treating advanced CCA, surveillance has been suggested as a strategy for detection of early disease in the high-risk group of patients with primary sclerosing cholangitis (PSC). In this review we present an updated overview of the epidemiology of CCA. We also highlight the risk of CCA in PSC with special focus on surveillance strategies.
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Affiliation(s)
- Annika Bergquist
- Centre for Digestive Diseases, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik von Seth
- Centre for Digestive Diseases, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Saha M, Nahar K, Hosen MA, Khan MH, Kumar Saha S, Shil BC, Rahman MH. Prevalence and Risk Factors of Asymptomatic Gallstone Disease in North-East Part of Bangladesh. Euroasian J Hepatogastroenterol 2015; 5:1-3. [PMID: 29201675 PMCID: PMC5578509 DOI: 10.5005/jp-journals-10018-1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/06/2014] [Indexed: 12/29/2022] Open
Abstract
Background The study was designed to assess the prevalence of asymptomatic gallstone disease in North-East part of Bangladesh. Materials and methods Randomly selected asymptomatic persons, unknown to have gallstone disease, from both rural and urban areas were enrolled. They were subjected to abdominal ultrasonography and findings were recorded in a data sheet. Results Total 1,019 persons (316 males and 703 females) were examined. Age of them varied from 18 to 80 years with mean age of 37.22 years. Out of them, 61 (6%) persons were found to have gallstone. Among them, 14 were males and 47 were females. Both male and females of age below 40 years were more affected. Gallstone disease was found more commonly among housewives and middle class people. Among 61 patients with gallstone, seven were underweight (11.47%), 32 (52.45%) had normal weight and 22 (36.06%) were overweight, obese or extremely obese. But, this difference was not statistically significant (p = 0.894). Conclusion Prevalence of asymptomatic gallstone disease was found in 6% apparently healthy subjects of North-East part of Bangladesh. It was more prevalent among housewives and middle class group of population. It is also common among the people of age group below 40 years. How to cite this article Saha M, Nahar K, Hosen MMA, Khan MH, Saha SK, Shil BC, Rahman MH. Prevalence and Risk Factors of Asymptomatic Gallstone Disease in North-East Part of Bangladesh. Euroasian J Hepato-Gastroenterol 2015;5(1):1-3.
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Affiliation(s)
- Madhusudan Saha
- Department of Gastroenterology, North East Medical College, Sylhet, Bangladesh
| | - Kamrun Nahar
- Nuclear Medicine and Ultrasound Center, Sylhet, Bangladesh
| | - Mm Arif Hosen
- Nuclear Medicine and Ultrasound Center, Sylhet, Bangladesh
| | - M H Khan
- Nuclear Medicine and Ultrasound Center, Sylhet, Bangladesh
| | - Shasanka Kumar Saha
- Department of Gastroenterology, Sir Salimullah Medical College, Dhaka, Bangladesh
| | - Bimal Chandra Shil
- Department of Gastroenterology, Sir Salimullah Medical College, Dhaka, Bangladesh
| | - Md Habibur Rahman
- Department of Gastroenterology, Sir Salimullah Medical College, Dhaka, Bangladesh
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Lavenant-Borja MI, Fernández-Rivero J, Pachuca-González D, Mercado MA, Esquivel-Ayanegui F, Méndez-Sánchez N, Albores-Saavedra J, Chablé-Montero F. Hepatolithiasis with secondary cholangitis and supernumerary left hepatic lobe. Ann Hepatol 2013; 12:966-968. [PMID: 24114828 DOI: 10.1016/s1665-2681(19)31303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
We report the case of a 31-year old woman with recurrent cholangitis secondary to hepatolithiasis. The stones were composed of calcium bilirubinate. The patient also had a supernumerary hepatic lobe connected to the inferior aspect of the segment III of the liver. The role of the supernumerary hepatic lobe in the development of hepatolithiasis is unclear and may be coincidental.
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Fang CH, Liu J, Fan YF, Yang J, Xiang N, Zeng N. Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique. J Am Coll Surg 2013; 217:280-288. [PMID: 23870220 DOI: 10.1016/j.jamcollsurg.2013.03.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/22/2013] [Accepted: 03/26/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of our study was to evaluate the perioperative and long-term outcomes of hepatectomy based on 3-dimensional reconstruction technique for hepatolithiasis by comparing it with traditional hepatectomy. STUDY DESIGN From December 2005 to September 2012, 56 consecutive patients underwent hepatectomy based on 3-dimensional reconstruction technique for hepatolithiasis in our hospital (group A). During the same period, 42 patients with hepatolithiasis who met the inclusion criteria for hepatectomy were selected for traditional hepatectomy (group B). All operations were performed by the authors. There was no significant difference in preoperative data between the 2 groups statistically. RESULTS Compared with patients in group B, those in group A had a significantly lower stone residual rate (intermediate rate, 3.6% vs 19.0%; final rate, 0% vs 9.5%) and stone recurrence rate (3.6% vs 23.8%), a lower intrahepatic duct stricture residual rate (1.8% vs 14.3%), and a faster operating time (218.8 ± 55.5 minutes vs 254.7 ± 65.6 minutes). Intraoperative blood transfusion, intraoperative blood loss, postoperative hospital stay, and recurrent cholangitis rate were similar. No significant dominance was found in group A with respect to serum aminotransferase level, serum bilirubin level, serum albumin level, and prothrombin time. There was a significant dominance in group A for serum hemoglobin level (116.3 ± 16.0 g/L vs 108.0 ± 13.9 g/L; p < 0.05). Twenty-two complications occurred, 10 in group A and 12 in group B. Neither group had any perioperative mortality. CONCLUSIONS Hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique is feasible and safe in selected patients. Compared with traditional hepatectomy, it is more effective for diagnosis and treatment of hepatolithiasis.
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Affiliation(s)
- Chi-hua Fang
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Chang JS, Tsai CR, Chen LT. Medical risk factors associated with cholangiocarcinoma in Taiwan: a population-based case-control study. PLoS One 2013; 8:e69981. [PMID: 23894567 PMCID: PMC3718690 DOI: 10.1371/journal.pone.0069981] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/14/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cholangiocarcinoma, including intra- and extrahepatic cholangiocarcinoma, is a rare but highly lethal cancer. Despite effort in finding the risk factors of cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown. This study utilized a population-based case-control design using data from the National Health Insurance Research Database (NHIRD) of Taiwan to assess the medical conditions associated with cholangiocarcinoma. METHODS 5,157 incident cases of cholangiocarcinoma diagnosed during 2004 to 2008 and 20,628 controls matched to the cases on sex, age, and time of diagnosis (reference date for the controls) were identified from the NHIRD. Medical risk factors were ascertained from the NHIRD for each individual. Conditional logistic regression was performed to evaluate the association between cholangiocarcinoma and each medical risk factor. RESULTS The results showed that factors associated with an increased risk of cholangiocarcinoma included cholangitis, cholelithiasis, cholecystitis, cirrhosis of liver, alcoholic liver disease, chronic non-alcoholic liver disease, hepatitis B, hepatitis C, diabetes, chronic pancreatitis, inflammatory bowel disease, and peptic ulcer. In addition, sex and age differences were observed. CONCLUSIONS This study confirms the association between cholangiocarcinoma and several less established risk factors, including diabetes, inflammatory bowel disease, hepatitis B, hepatitis C, and peptic ulcer (proxy for the presence of Helicobacter Pylori). Future studies should focus on finding additional environmental and genetic causes of cholangiocarcinoma.
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Affiliation(s)
- Jeffrey S. Chang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
- * E-mail: (JC); (LC)
| | - Chia-Rung Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Molecular Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (JC); (LC)
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Chang YR, Jang JY, Kwon W, Park JW, Kang MJ, Ryu JK, Kim YT, Yun YB, Kim SW. Changes in demographic features of gallstone disease: 30 years of surgically treated patients. Gut Liver 2013; 7:719-24. [PMID: 24312714 PMCID: PMC3848536 DOI: 10.5009/gnl.2013.7.6.719] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/30/2012] [Indexed: 12/20/2022] Open
Abstract
Background/Aims The aim of this study was to investigate changes in the clinical and demographical characteristics of gallstone disease in Korea, based on 30 years of surgically treated patients at a single institute. Methods In total, 7,949 gallstone patients who underwent surgery between 1981 and 2010 were analyzed. Patients were divided into six time periods: period I (1981 to 1985, n=831), period II (1986 to 1990, n=888), period III (1991 to 1995, n=1,040), period IV (1996 to 2000, n=1,261), period V (2001 to 2005, n=1,651) and period VI (2006 to 2010, n=2,278). Results The total number and mean age of the patients gradually increased, and the male/female ratio decreased. The proportion of gallbladder (GB)-stone cases increased, whereas the proportions of common bile duct (CBD)- and intrahepatic duct (IHD)-stone cases decreased. Differences in patient geographical origins also decreased. Based on the relationship between changes in the prevalence of gallstone disease and socioeconomic status, the prevalence of CBD stones showed a strong correlation with Engel's coefficient (p<0.001). Conclusions Our study indicates that although the total number of cases and the mean age of gallstone patients have continuously increased, there are trends of increasing GB-stone cases and decreasing CBD- and IHD-stone cases.
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Affiliation(s)
- Ye Rim Chang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lee JY, Kim JS, Moon JM, Lim SA, Chung W, Lim EH, Lee BJ, Park JJ, Bak YT. Incidence of Cholangiocarcinoma with or without Previous Resection of Liver for Hepatolithiasis. Gut Liver 2013; 7:475-9. [PMID: 23898390 PMCID: PMC3724038 DOI: 10.5009/gnl.2013.7.4.475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 07/22/2012] [Accepted: 09/07/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS To investigate the incidence of cholangiocarcinoma in patients with hepatolithiasis with or without previous resection of liver. METHODS From 2002 to 2009, we retrospectively reviewed 117 patients who were diagnosed and treated for hepatolithiasis in Korea University Guro Hospital. Among the 117 patients, 55 patients who were lost during follow-up were excluded, and 62 patients were eligible for analysis. The hepatic resection group (n=25) included patients who underwent left hemihepatectomy (n=2); left lateral segmentectomy (n=10); left lobectomy (n=9); right lobectomy (n=3); or wedge resection (n=1). The nonhepatic resection group (n=37) included transhepatic cholangiographic lithotomy and endoscopic retrograde cholangiopancreatography-treated patients. The mean follow-up period was 47 months. RESULTS The incidence of cholangiocarcinoma while patients were followed for hepatolithiasis was 12.9% (8/62) (hepatic resection group, three cases [12%] vs nonhepatic resection group, five cases [13.5%]; p=1.000). The mean follow-up period was 53 months (47±11 months) until the diagnosis of cholangiocarcinoma. CONCLUSIONS There was no difference in the incidence of cholangiocarcinoma according to previous liver resections. Patients with hepatolithiasis should be carefully followed up for detection of cholangiocarcinoma even after a previous liver resection.
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Affiliation(s)
- Joon Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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ERCP service in China: results from a national survey. Gastrointest Endosc 2013; 77:39-46.e1. [PMID: 23261093 DOI: 10.1016/j.gie.2012.08.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/30/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND ERCP had been performed throughout China for decades. OBJECTIVE To determine the status of ERCP service in China. DESIGN A national survey. SETTING All of the hospitals performing ERCP in mainland China in 2006. PATIENTS All of the patients undergoing ERCP in mainland China in 2006. MAIN OUTCOME MEASUREMENTS The questionnaire included the (1) type of hospitals involved; (2) ownership of the endoscopy unit; (3) ERCP infrastructure; (4) volume, indication, setting, and anesthesia methods; and (5) training and research. The correlation between economic development and ERCP status in different regions was investigated, and the ERCP rates in China and developed countries were compared. RESULTS Completed questionnaires were returned by 449 (95.5%) of the 470 hospitals providing ERCP service. Among the 449 hospitals, 186 (41.4%) did not have separate ERCP suites, 379 (84.4%) shared fluoroscopy with their radiology departments, and the average number of duodenoscopes was 1.58. A total of 63,787 ERCP procedures were performed in mainland China in 2006, with an estimated annual ERCP rate of 4.87 per 100,000 inhabitants, much lower than that of developed countries. Ninety-six percent of patients were admitted to undergo ERCP, and 94.4% of hospitals used pharyngeal local anesthesia and conscious sedation, whereas 5.6% used general anesthesia. There was a significant correlation between the ERCP rate and gross domestic product per capita (r = 0.871, P < .001). LIMITATIONS The survey was retrospective and descriptive. CONCLUSIONS There is an enormous gap in ERCP service between China and developed countries. The imbalance of ERCP status between different regions is significant, which correlates with economic development. Great effort is needed to develop the technique nationwide.
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Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012; 6:172-87. [PMID: 22570746 PMCID: PMC3343155 DOI: 10.5009/gnl.2012.6.2.172] [Citation(s) in RCA: 723] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/20/2011] [Indexed: 12/12/2022] Open
Abstract
Diseases of the gallbladder are common and costly. The best epidemiological screening method to accurately determine point prevalence of gallstone disease is ultrasonography. Many risk factors for cholesterol gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstone frequency. Risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones. Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians. Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps.
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Affiliation(s)
- Laura M Stinton
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada
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Right hepatolithiasis and abnormal hepatic duct confluence: more than a casual relation? Am J Surg 2010; 201:514-8. [PMID: 20870207 DOI: 10.1016/j.amjsurg.2010.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 02/24/2010] [Accepted: 02/26/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hepatolithiasis (HL) is a rare disease in Western countries. The aim of our study was to investigate a possible relation between the development of right HL and abnormalities of the hepatic duct confluence. MATERIAL AND METHODS Fourteen patients who presented with localized right-sided HL were included in this study. The anatomy of hepatic duct confluence in this group of patients was analyzed and compared with the anatomy of hepatic duct confluence in the general population. RESULTS The Presence of a shift of 1 of the 2 sectorial right ducts was significantly associated with right-sided HL (P = .003). CONCLUSIONS The shift of a sectorial right duct must be considered as one of the anatomic causes of HL. This finding must be considered when surgical treatment of HL is planned.
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An appraisal of anatomical and limited hepatectomy for regional hepatolithiasis. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2010; 2010:791625. [PMID: 20300546 PMCID: PMC2838363 DOI: 10.1155/2010/791625] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 01/28/2010] [Accepted: 02/16/2010] [Indexed: 02/05/2023]
Abstract
Aim. Determination of first line treatment with limited hepatectomy or Anatomical hepatectomy provides better clinical outcome. Methods. Immediate and long-term outcomes of 106 patients who underwent partial hepatectomy for RH at our institution from January 2001 to February 2005 were analyzed retrospectively. Clinical end-points included time to recovery of hepatic function, residual stones, infection of the liver remnant, bile leakage, recurrent stones, morbidity, and mortality. Results. LH was performed in 59 patients and AH in 47 patients as first-line treatment. The time of hepatic function recovery was not statistically different between the two groups (P > .05). However, Patients in AH group suffered from less residual stones (P < .05), less infection of the raw surface of liver remnant (P < .05), and less bile leakage (P < .05), with a median follow-up of 40.3 ± 0.8 months (range 3–48), and AH group suffered a less recurrent stone rate (P < .05). No difference in morbidity, and mortality rates between the two groups. Conclusion. AH is a safe and effective treatment for RH, with a fair rate of surgical complications, it should be considered as first-line treatment of RH.
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Huang J, Chang CH, Wang JL, Kuo HK, Lin JW, Shau WY, Lee PH. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC Gastroenterol 2009; 9:63. [PMID: 19698126 PMCID: PMC2746226 DOI: 10.1186/1471-230x-9-63] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 08/22/2009] [Indexed: 12/14/2022] Open
Abstract
Background Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged ≥20. Methods A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997–2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution. Results The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59–0.60) for men and 0.59 (0.59–0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20–39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged ≥60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy. Conclusion This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20–39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged ≥60.
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Affiliation(s)
- John Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
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Abstract
Gallstone disease exacts a considerable financial and social burden worldwide leading to frequent physician visits and hospitalizations. Based on their composition, gallstones are categorized as cholesterol, black pigment, and brown pigment, with each category having a unique structural, epidemiologic, and risk factor profile. Cholesterol crystal formation requires the presence of one or more of the following: (a) cholesterol supersaturation, (b) accelerated nucleation, or (c) gallbladder hypomotility/bile stasis. Some risk factors for cholesterol stones include age, gender, genetics, obesity, rapid weight loss, and ileal disease. Generally, pigment stones are formed by the precipitation of bilirubin in bile, with black stones associated with chronic hemolytic states, cirrhosis, Gilbert syndrome, or cystic fibrosis, and brown stones associated with chronic bacterial or parasitic infections.
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Uenishi T, Hamba H, Takemura S, Oba K, Ogawa M, Yamamoto T, Tanaka S, Kubo S. Outcomes of hepatic resection for hepatolithiasis. Am J Surg 2009; 198:199-202. [PMID: 19249730 DOI: 10.1016/j.amjsurg.2008.08.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/02/2008] [Accepted: 08/05/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hepatic resection is main approach to treatment of hepatolithiasis, but the long-term follow-up results of hepatic resection for hepatolithiasis are rarely reported. METHODS A retrospective study was conducted of 87 patients with hepatolithiasis who underwent hepatic resection. RESULTS The final stone clearance rates were 95%. There was a significant difference in the incidence of recurrent stones between patients with and without remaining biliary strictures. On multivariate analysis, the presence of residual or recurrent stones was an independent risk factor associated with recurrent cholangitis. The 10-year overall survival rate was 80.3%. On multivariate analysis, the development of cholangiocarcinoma was an independent predictor of survival in patients who underwent hepatic resection for hepatolithiasis. CONCLUSIONS The long-term outcomes after hepatic resection were satisfactory in patients whose intrahepatic stones and strictures were completely removed. Cholangiocarcinoma associated with hepatolithiasis was an independent prognostic factor in patients with hepatolithiasis who underwent hepatic resection.
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Affiliation(s)
- Takahiro Uenishi
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University, Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
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Abstract
Gallstone disease is one of the most prevalent gastrointestinal disorders. In addition, the costs associated with the diagnosis and treatment of gallstone disease have been rapidly increasing. The etiology and pathogenesis of gallstone disease remains incompletely understood. Gallstone formation may result from a complex interaction of genetic and environmental factors. This article reviews the prevalence and risk factors associated with gallstone disease. Understanding the pathogenesis of gallstone disease could lead to the development of better therapeutic and preventive strategies for dealing with this disease.
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Affiliation(s)
- Eun-Hyung Yoo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nakai A, Imano M, Takeyama Y, Shiozaki H, Ohyanagi H. An immunohistochemical study of osteopontin in hepatolithiasis. ACTA ACUST UNITED AC 2008; 15:615-21. [PMID: 18987932 DOI: 10.1007/s00534-007-1320-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 12/13/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND/PURPOSE Mucin glycoprotein from the intrahepatic bile ducts, and from the intramural and extramural glandular epithelia, is thought to contribute to the formation of the matrix, or nucleus, in hepatolithiasis and to contribute to biomineralization systems. Osteopontin (OPN), a noncollagenous acidic bone matrix glycoprotein that possesses calcium-binding properties. To investigate the role of OPN in the genesis of hepatolithiasis, OPN was immunohistochemically studied in the intrahepatic bile ducts, intramural and extramural glands, and in stones. METHODS An immunohistochemical study was performed in 21 human liver specimens with hepatolithiasis, by the EnVision (Dako Japan, Kyoto, Japan) method. RESULTS Staining for OPN was strongly positive in the epithelium of stone-laden intrahepatic bile ducts, intramural and extramural glands, and in stones. The stone-laden intrahepatic bile ducts were infiltrated by macrophages showing intense staining for OPN. Sections of the hepatolithiasis, viewed under low magnification, showed a lamellar pattern of OPN immunolabeling, and they showed a reticular pattern under high magnification. In the center of the stones, large nestlike membranous structures were frequently present. CONCLUSIONS Our result indicates that OPN, an acidic glycoprotein from intrahepatic bile ducts and from intramural and extramural glandular epithelia, seems to be involved in lithiasis, both as a core protein in the early phase, and in the late phase.
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Affiliation(s)
- Akihiro Nakai
- Department of Surgery, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Momiyama M, Wakai K, Oda K, Kamiya J, Ohno Y, Hamaguchi M, Nakanuma Y, Hsieh LL, Yeh TS, Chen TC, Jan YY, Chen MF, Nimura Y. Lifestyle risk factors for intrahepatic stone: findings from a case-control study in an endemic area, Taiwan. J Gastroenterol Hepatol 2008; 23:1075-81. [PMID: 18086119 DOI: 10.1111/j.1440-1746.2007.05258.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM To examine associations between lifestyle risk factors and intrahepatic stone (IHS), we conducted a case-control study in Taiwan, which has the highest incidence of IHS in the world. METHODS Study subjects were 151 patients newly diagnosed with IHS at Chang Gung Memorial Hospital between January 1999 and December 2001. Two control subjects per case were selected randomly from patients who underwent minor surgery at the same hospital and from family members or neighbors of the hospital staff. Controls were matched to each case by age and gender. Information on lifestyle factors was collected using a self-administered questionnaire. Strength of associations was assessed using odds ratios derived from conditional logistic models. RESULTS Female patients were significantly shorter than female controls. Compared to subjects with two or fewer children, odds ratios for those with six or more children were 20.4 in men (95% confidence interval, 1.89-221) and 2.82 (0.97-8.22) in women. Increasing level of education lowered the risk of intrahepatic stone (trend P = 0.004 for men and < 0.0001 for women). Women who had consumed ground-surface water for a long period had a somewhat increased risk (trend P = 0.05). CONCLUSION Lower socioeconomic status and poor hygiene may be involved in the development of intrahepatic stones.
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Affiliation(s)
- Masato Momiyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Yoo EH, Oh HJ, Lee SY. Gallstone analysis using Fourier transform infrared spectroscopy (FT-IR). Clin Chem Lab Med 2008; 46:376-381. [PMID: 18254703 DOI: 10.1515/cclm.2008.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gallstone analysis is important in determining the possible etiology of stone formation and the pathophysiology of cholelithiasis. Physical analysis using Fourier transform infrared spectroscopy (FT-IR), compared to chemical analysis, requires minimal sample volume, shows uniform sensitivity and specificity for all components and provides quantitative results with greater reproducibility. We studied the characteristics and distribution of gallstones using FT-IR in addition to the risk factors for gallstone formation in Korean patients. A better understanding of the mechanism underlying stone formation may help prevent gallstone development. METHODS Physical analysis of gallstones in 490 patients who underwent cholecystectomy was carried out using the FT-IR system 2000 (Perkin-Elmer Co.) and Spectrum software (Perkin-Elmer Co.). Visual inspection of the size, color, consistency and surface of the stones was compared with the physical characteristics. Clinical, demographic and laboratory findings were evaluated and compared with the gallstone components. RESULTS The FT-IR evaluation showed that most gallstones were composed of a single component (84.1%); cholesterol was the most commonly observed element among the major components (50%, 245/490). Morphological classification according to color, consistency and surface was different from the FT-IR composition analysis. There were significant differences in the components based on age, obesity, education level and the presence of diabetes mellitus. CONCLUSIONS The results of this study show that physical analysis of gallstones with FT-IR provides important information on stone composition, distribution and risk factors. These study results will help improve our understanding of the pathophysiology of gallstone disease in the Korean population, where there is a high frequency of hepatobiliary disorders.
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Affiliation(s)
- Eun-Hyung Yoo
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
AIM Surgical and nonsurgical procedures for management of hepatolithiasis have been reported. The aim of this study was to evaluate immediate and long-term results of hepatectomy as treatment for hepatolithiasis. MATERIALS AND METHODS Immediate and long-term outcomes of 123 consecutive patients who underwent hepatectomy for hepatolithiasis at our institution from 2000 to 2005 were analyzed retrospectively. Acute cholangitis was the major presenting symptom (in 106 out of 123, 86.2% of cases). RESULTS The immediate stone clearance rate was 92.7% (114 out of 123) and final stone clearance rate was 96% (118 out of 123) after subsequent T-tube route or endoscopic retrograde cholangiopancreatography (ERCP). Residual stones were identified in 5 patients (4%). The surgical morbidity and mortality rates were 33.3% (41 out of 123) and 1.6% (2 out of 123) respectively. Of the 123 patients, 3 (2.4%) had associated cholangiocarcinoma at the time of hepatectomy. With a median follow-up of 40.3 months (range 5-58), a recurrent stone developed in 7 patients (5.7%) and cholangiocarcinoma in 2 (1.6%). Ten patients died during the follow-up period, with 4 of them (out of 123, 3.2%) due to recurrent stone with sepsis. CONCLUSION Hepatectomy is a safe and effective treatment for hepatolithiasis, with a high stone clearance rate and fair rate of surgical complications. Recurrent stone-induced sepsis and cholangiocarcinoma are the major factors compromising long-term survival in these patients.
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Affiliation(s)
- Tung-Yen Lee
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Lee KT, Chang WT, Wang SN, Chuang SC, Chai CY, Hu SW. Expression of DPC4/Smad4 gene in stone-containing intrahepatic bile duct. J Surg Oncol 2006; 94:338-43. [PMID: 16917866 DOI: 10.1002/jso.20517] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Hepatolithiasis is etiologically related to cholangiocarcinoma. We underwent this study with an attempt to examine the expression of DPC4/Smad4 gene in stone-containing intrahepatic bile ducts (IHD) and intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS The immunohistochemical method and RT-PCR analysis were used to study the expression of DPC4/Smad4 gene in normal IHD, stone-containing IHD, and ICC. All the specimens were from hepatic resection. RESULTS The immunohistochemical study showed that all specimens from 24 normal IHD had marked expression of DPC4/Smad4 gene, while there was 4.4% (2/46) and 33.3% (3/9) loss of DPC4/Smad4 expression in stone-containing IHD and ICC, respectively. Among the specimens of stone-containing IHD, all the hyperplastic epithelial cells showed normal expression of DPC4/Smad4 gene while dysplastic epithelial cells showed 20% (2/10) loss expression of DPC4/Smad4. The RT-PCR analysis showed that the normal IHD had the highest content of DPC4/Smad4 mRNA, which was threefold and sixfold higher than that of stone-containing IHD and ICC, respectively. CONCLUSION Loss expression of DPC4/Smad4 gene was found both in stone-containing IHD and ICC. Dysplastic epithelium of stone-containing IHD had higher potential for malignant transformation.
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Affiliation(s)
- King-Teh Lee
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Lee JK, Ryu JK, Park JK, Yoon WJ, Lee SH, Lee KH, Kim YT, Yoon YB. Risk factors of acute cholecystitis after endoscopic common bile duct stone removal. World J Gastroenterol 2006; 12:956-60. [PMID: 16521227 PMCID: PMC4066164 DOI: 10.3748/wjg.v12.i6.956] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct (CBD) stone removal.
METHODS: A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder (GB) in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis: age, gender, serum bilirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications.
RESULTS: During a mean 18-mo follow-up, 28 (28%) patients developed biliary symptoms; 17 (17%) acute cholecystitis and 13 (13%) CBD stone recurrence. Of patients with acute cholecystitis, 15 (88.2%) received laparoscopic cholecystectomy and 2 (11.8%) open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo (1-37 mo) and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 (11.8%) developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bilirubin level of
<1.3 mg/dL and a CBD diameter of <11 mm at the time of stone removal were found to predict the development of acute cholecystitis.
CONCLUSION: After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct (<11 mm) and jaundice (<1.3 mg/dL) at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.
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Affiliation(s)
- Jun Kyu Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744 Seoul, Korea
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Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol 2006; 20:1075-83. [PMID: 17127189 DOI: 10.1016/j.bpg.2006.05.009] [Citation(s) in RCA: 308] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gallstones are common in Western countries and Japan. Most gallstones are found in the gallbladder, but they sometimes pass through the cystic duct into extrahepatic and/or intrahepatic bile ducts to become bile-duct stones, causing conditions known as choledocholithiasis and hepatolithiasis. Some 10-15% of gallstone patients concomitantly suffer from bile-duct stones. Bile-duct stones can also be formed in the absence of gallbladder stones, and such primary bile-duct stones are more common in East Asian countries than in the Western world. Thus pathogenesis of primary and secondary bile-duct stones is unlikely to be similar. Furthermore, the gallbladder stones are primarily cholesterol or black-pigment stones, whereas most bile-duct stones are brown-pigment stones (calcium bilirubin stones). Thus, epidemiology, pathogenesis and classification of biliary stones are very likely to differ according to stone location (intrahepatic and/or extrahepatic bile duct).
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Affiliation(s)
- Susumu Tazuma
- Department of General Medicine and Clinical Pharmacotherapeutics, Hiroshima University Hospital and Graduate School of Biomedical Sciences, 1-2-3, Kasumi, Hiroshima 734-8551, Japan.
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Abstract
Gallstone disease is common: >700,000 cholecystectomies and costs of approximately 6.5 billion dollars annually in the U.S. The burden of disease is epidemic in American Indians (60-70%); a corresponding decrease occurs in Hispanics of mixed Indian origin. Ten to fifteen per cent of white adults in developed countries harbour gallstones. Frequency is further reduced in Black Americans, East Asia and sub-Saharan Africa. In developed countries, cholesterol gallstones predominate; 15% are black pigment. East Asians develop brown pigment stones in bile ducts, associated with biliary infection or parasites, or in intrahepatic ducts (hepatolithiasis). Certain risk factors for gallstones are immutable: female gender, increasing age and ethnicity/family (genetic traits). Others are modifiable: obesity, the metabolic syndrome, rapid weight loss, certain diseases (cirrhosis, Crohn's disease) and gallbladder stasis (from spinal cord injury or drugs like somatostatin). The only established dietary risk is a high caloric intake. Protective factors include diets containing fibre, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity.
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Affiliation(s)
- Eldon A Shaffer
- Division of Gastroenterology, Health Science Centre, University of Calgary, 3330 Hospital Dr SW, Calgary, Alberta T2N4N1, Canada.
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Abstract
Hepatolithiasis (oriental cholangiohepatitis) has reportedly been endemic only in East Asia. The disease is now occasionally recognized in Western societies, especially in people who have lived in the Orient. Hepatolithiasis is characterized by its intractable nature and frequent recurrence, requiring multiple operative interventions, which is in distinct contrast to gallbladder stones. In addition to frequent cholangitis and chronic sepsis, it is widely known that longstanding intrahepatic stones lead to intrahepatic cholangiocarcinoma. Symptoms of hepatolithiasis include abdominal pain, jaundice and cholangitis. Pyogenic cholangitis due to strictures and hepatolithiasis tends to recur, and sometimes patients may present with liver abscesses. Radiological studies and percutaneous procedures are keys in the diagnosis and treatment of hepatolithiasis. Non-invasive imaging modalities such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) accurately depict the normal anatomy and presence of intrahepatic stones. It should be stressed that each modality has its pros and cons, and imaging studies should be performed on the basis of understanding the pathophysiology. As the diagnostic role of magnetic resonance cholangiopancreatography (MRCP) evolves, the roles of both endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), and their most significant advantage, is primarily therapeutic with their ability to extract stones, biopsy intraductal lesions, and place stents easily. The primary goals of treatment are to eliminate attacks of cholangitis and to stop the progression of the disease (which leads to biliary cirrhosis). Surgery has a primary role in hepatolithiasis because hepatolithiasis tends to recur, so that multiple sessions of the endoscopic approach (i.e. two or three times a year) are often required. PTC is an alternative when surgical resection of the affected lobe is difficult. Techniques for lithotripsy, including shockwave and laser, can be applied in endoscopic sessions, offering a better chance of clearing the stones.
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Affiliation(s)
- Toshiyuki Mori
- Department of Surgery, Kyorin University, 6-20-2 Shinkawa Mitaka, Tokyo, 181-8611, Japan.
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Tsai WL, Lai KH, Lin CK, Chan HH, Lo CC, Hsu PI, Chen WC, Cheng JS, Lo GH. Composition of common bile duct stones in Chinese patients during and after endoscopic sphincterotomy. World J Gastroenterol 2005; 11:4246-4249. [PMID: 16015699 PMCID: PMC4615452 DOI: 10.3748/wjg.v11.i27.4246] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Revised: 01/01/2004] [Accepted: 01/05/2004] [Indexed: 02/06/2023] Open
Abstract
AIM Endoscopic sphincterotomy (ES) is a well-established therapeutic modality for the removal of common bile duct (CBD) stones. After ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and after ES and its clinical significance in Chinese patients. METHODS From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared (IR) spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed. RESULTS In the initial 266 stone samples, 217 (82%) were bilirubinate stones, 42 (16%) were cholesterol stones, 3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones (66+/-13 years vs 56+/-17 years, P = 0.001). In the 44 recurrent stone samples, 38 (86%) were bilirubinate stones, 3 (7%) were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained, 23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack. CONCLUSION Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients. The composition of CBD stones may be different from initial stones after ES.
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Affiliation(s)
- Wei-Lun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang Ming University, Taiwan, China
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Park YH, Park SJ, Jang JY, Ahn YJ, Park YC, Yoon YB, Kim SW. Changing patterns of gallstone disease in Korea. World J Surg 2004; 28:206-10. [PMID: 14708060 DOI: 10.1007/s00268-003-6879-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this study was to investigate the epidemiologic characteristics and changing patterns of gallstone disease in Korea over a recent 20-year period. A total of 4020 gallstone patients who had undergone surgery at Seoul National University Hospital during 1981-2000 were analyzed according to periods: period I (1981-1985: 831 cases); period II (1986-1990: 888 cases); period III (1991-1995: 1040 cases); period IV (1996-2000: 1261 cases). The literature from 13 institutes in Korea reporting a total of 13,101 gallstone cases were reviewed to elucidate the nationwide trend. The number of gallstone cases gradually increased. A female predominance was not noted (F/M = 1.17-1.37) as is seen in Western countries. The patients with common bile duct (CBD) stones were older than those with gallbladder (GB) stones or intrahepatic duct (IHD) stones. Over time, the relative proportion of those with a GB stone increased, plateauing (80-85%) during the 1990s; that of patients with CBD stones decreased (34% --> 19%); and that of those with IHD stones remained unchanged (11-15%). Over the entire period, the rural pattern of gallstone formation (low number of GB stones, high numbers of CBD and IHD stones) has become similar to the urban pattern. The body mass index (BMI) of the GB stone group was above average, as were the BMIs of the CBD stone and IHD stone groups. Throughout the literature review, this same changing pattern of the relative proportion of gallstone disease was confirmed. Thus the pattern of gallstone disease in Korea has become similar to that seen in Western countries except for a high prevalence of hepatolithiasis.
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Affiliation(s)
- Yong-Hyun Park
- Department of Surgery, Seoul National University, College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744 Seoul, Korea
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Abstract
BACKGROUND Hepatolithiasis is a well-known etiology of cholangiocarcinoma. However, whether or not hepatolithiasis influences the presentation of cholangiocarcinoma is not very clear. To help clarify this, we conducted the present study to investigate the clinicopathological characteristics of cholangiocarcinoma with hepatolithiasis. As well, we made a comparison between the presence and absence of hepatolithiasis in patients with cholangiocarcinoma to determine the impact of hepatolithiasis. METHODS Among 140 patients with histologically proven cholangiocarcinoma at the Taichung Veteran General Hospital between October 1982 and December 2000, 38 were found to have concomitant hepatolithiasis. Patients were evaluated on the basis of age, gender, presenting symptom, laboratory data, preoperative liver function (indocyanine green test), tumor markers, histological differentiation, lymph node involvement, and organ metastasis. Data were statistically analyzed using the chi-squared test and Student's t-test. Analysis of survival was performed using the Kaplan-Meier method, and univariate analysis and multivariate analyses for survival were performed by Cox proportional hazard model. RESULTS The cholangiocarcinoma with hepatolithiasis group (CC + HL) was found to be predominantly female, with more common presentation of fever and less presentation of jaundice (P < 0.05). In addition, patients with cholangiocarcinoma without hepatolithiasis (CC - HL group) had higher serum bilirubin levels and more advanced histological differentiation (P < 0.05). As well, the percentage of resectability of the CC + HL group was higher than that of the CC - HL group, although it was not statistically significant. Univariate and multivariate analyses for overall survival showed that those patients with an age older than 65 years, hypoalbuminemia, poor histological differentiation, and a presence of hepatolithiasis were prone to a graver prognosis, albeit none of them were statistically significant. Resectability was the only independent predictor of a favorable prognosis with significant difference. CONCLUSIONS The clinicopathological features of cholangiocarcinoma with concomitant hepatolithiasis showed few differences from that without hepatolithiasis. Resectability was the only predictor that favored a good prognosis.
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Affiliation(s)
- Cheng-Chi Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
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Lee YC, Wang HP, Huang SP, Chang YT, Wu CT, Yang CS, Wu MS, Lin JT. Obstructive jaundice caused by hepatocellular carcinoma: detection by endoscopic sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:363-366. [PMID: 11424104 DOI: 10.1002/jcu.1050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Tumor thrombus in the extrahepatic biliary tree is a rare mechanism of obstructive jaundice. We present a patient with a minute hepatocellular carcinoma in the caudate lobe that invaded the common hepatic duct and caused biliary obstruction. Endoscopic sonography showed a tumor thrombus with central echogenicity and a "nodule-in-nodule" pattern and suggested the correct diagnosis.
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Affiliation(s)
- Y C Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, 1, Jen-Ai Road, Taipei, Taiwan
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