Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2025; 31(12): 100855
Published online Mar 28, 2025. doi: 10.3748/wjg.v31.i12.100855
Characterization of gallbladder stones associated with occult pancreaticobiliary reflux using computed tomography
Chen Qiu, Yu-Kai Xiang, Hai Hu, Xuan-Bo Da, Gang Li, Yue-Yi Zhang, Hong-Lei Zhang, Cheng Zhang, Yu-Long Yang
Chen Qiu, Yu-Kai Xiang, Hai Hu, Xuan-Bo Da, Gang Li, Yue-Yi Zhang, Hong-Lei Zhang, Cheng Zhang, Yu-Long Yang, Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, Tongji University School of Medicine, Shanghai 200120, China
Co-first authors: Chen Qiu and Yu-Kai Xiang.
Co-corresponding authors: Cheng Zhang and Yu-Long Yang.
Author contributions: Yang YL conceptualized and designed the study. Zhang C and Hu H contributed to the study design and manuscript revision and provided critical feedback. Da XB and Zhang HL were responsible for patient screening and enrollment and collection of clinical data. Li G and Zhang YY conducted the image feature extraction and initial data processing. Qiu C and Xiang YK performed the data analysis and statistical validation and drafted the manuscript; Yang YL supervised the entire project, provided guidance in data interpretation, and critically revised the manuscript for important intellectual content; All authors read and approved the final manuscript. Yang YL and Zhang C contributed equally to the study as co-corresponding authors. Yang YL was responsible for the overall study design, data interpretation, and manuscript preparation. Zhang C played a crucial role in study supervision, manuscript revision, and submission. Their collaboration was essential for the successful completion and publication of this manuscript.
Supported by Key Specialty Construction Project of Shanghai Pudong New Area Health Commission, No. PWZzk2022-17; Shanghai East Hospital Clinical Research Project, No. DFLC2022019; and the Featured Clinical Discipline Project of Shanghai Pudong District, No. PWYts2021-06.
Institutional review board statement: This study was authorized by the local ethics committee of East Hospital Affiliated to Tongji University (No. 2022-107).
Informed consent statement: Patients consented to the extraction of bile samples during surgery and signed informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Long Yang, Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China. yyl516@tongji.edu.cn
Received: August 30, 2024
Revised: January 10, 2025
Accepted: February 18, 2025
Published online: March 28, 2025
Processing time: 209 Days and 23.8 Hours
Abstract
BACKGROUND

Occult pancreaticobiliary reflux (OPBR) is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.

AIM

To explore the computed tomography (CT) imaging characteristics of gallbladder stones in patients diagnosed with OPBR.

METHODS

We analyzed 362 patients undergoing cholecystectomy (November 2020 to January 2022). Intraoperative bile samples were assayed for amylase (> 110 U/L indicated OPBR). CT features, including stone density and visibility, were compared between 54 OPBR and 308 controls. Stone attenuation (HU) was measured under standardized conditions (uCT-780, 120 kVp, 160 mAs). Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors, forming a validated nomogram.

RESULTS

OPBR patients exhibited significantly higher rates of CT-invisible stones (35.2% vs 12.3%) and uniform stones (87% vs 73.1%) along with lower overall stone density (P = 0.01). Logistic regression identified stone visibility, uniformity, and density as independent predictors. A nomogram integrating these features with patient age achieved high diagnostic accuracy (area under the curve = 0.71).

CONCLUSION

CT imaging distinctly identifies gallbladder stone density, indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones. Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.

Keywords: Occult pancreaticobiliary reflux; Pancreaticobiliary maljunction; Pancreaticobiliary reflux; Computed tomography; Diagnostic model

Core Tip: This study presented a novel approach to diagnosing occult pancreaticobiliary reflux in patients with gallbladder stones using non-invasive computed tomography (CT) imaging. The findings highlighted that uniform and CT-invisible stones, along with lower stone density, are significant predictors of occult pancreaticobiliary reflux. The development of a predictive nomogram based on these imaging features offers clinicians an effective tool for early identification and intervention, potentially reducing the risk of recurrent biliary pathologies post-cholecystectomy. This innovative diagnostic model may enhance patient management and improve clinical outcomes in gallbladder disease.