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Abstract: Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Sleeve gastrectomy (SG) is an established bariatric procedure which produces substantial and rapid weight loss and hence can lead to an increase in gallstones development., Objectives: To demonstrate the early and late appearance of gallstones after SG., Materials and Methods: A prospective protocol was established in consecutive patients submitted to SG. Clinical and ultrasound evaluations were performed early (1 to 2 y) and late after surgery (over 6 y)., Results: From 109 patients included, 13 (13.1%) had a previous and 10 (10.1%) had simultaneous cholecystectomy at the time of SG. Therefore, 86 patients were submitted to surveillance. Seven patients were unreachable, leaving 79 patients for late follow-up. Forty-five patients (57%) had alithiasic gallbladder late after surgery, whereas 34 patients (43%) showed appearance of gallstone. From them, 53% developed gallstones late after surgery (mean, 7.5 y). Among the group with early development of stones, 69% were symptomatic and in the latter group only 17%., Conclusions: Study with 92% of follow-up late after SG demonstrated a 43% development of gallstones: half earlier and half late after surgery. We emphasize the need for late control to detect the real appearance of gallstones after SG.

We investigated possible associations between fatty liver and gallstone disease (GD) in a Chinese population.This cross-sectional study included 897 people who visited the clinical center and underwent ultrasonography at The First Hospital of Jilin University between January 2018 and June 2018.The overall prevalence of GD was 8.8%; the between-sex difference (9.3% in men, 8.4% in women) was not statistically significant. The risk of GD was similar for men and women across all age groups. GD prevalence increased steadily with increasing age, from 2.1% in patients ≤30 years of age to 15.4% in those >70 years of age. Older age (≥50 years) and fatty liver were associated with GD development. Diabetes mellitus (adjusted odds ratio [AOR]: 3.066; 95% confidence interval [CI]: 1.563-6.013) was associated with GD in female but not in male subjects. In younger patients (<50 years), fatty liver (AOR: 5.268; 95% CI: 1.832-15.147) was associated with GD development.The factors older age and fatty liver predicted GD risk in Chinese individuals. Further studies are required to explore differences in lithogenesis according to sex.

This study sought to evaluate the association between gastrectomy and the occurrence of gallstones using a national sample cohort from Korea.Data from 2002 to 2013 were collected for individuals ≥20 years of age in the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). We extracted data for patients who had undergone gastrectomy (n = 1998) and a 1:4 matched control group (n = 7992) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Gastrectomies were identified using operation codes (Q2533-Q2537, Q2594-Q2596, and Q2598). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using Cox proportional hazard models, and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed based on age and sex.The adjusted HR for gallstones was 1.77 (95% CI = 1.34-2.35, P < .001) in the gastrectomy group compared to control. Consistent HRs were found in the analyses of all of the subgroups determined using age and sex.The occurrence of gallstones was increased in the patients who had undergone gastrectomy compared to their matched control group.

Purpose of Review: Gallstone disease (GSD) and nonalcoholic fatty liver disease (NAFLD often coexist in a given patient and both conditions are associated to obesity and insulin resistance. The relationship between GSD and NAFLD is complex and bidirectional. In the present review, we summarize the existing information on the complex link between GSD and NAFLD and the potential implications for patient care., Recent Findings: Several clinical studies and systematic reviews have addressed the association between NAFLD and GSD underscoring that NAFLD is an independent risk factor for GSD. Conversely, GSD has been found also to be an independent risk factor for NAFLD with GSD potentially being linked to greater disease severity. In addition to the data showing association of NAFLD and GSD, recent evidence has also showed that cholecystectomy may itself be a risk factor for NAFLD development. The complex and bidirectional relationship between these diseases is partially explained by a number of common pathogenic links but the precise underlying mechanisms of the association of GSD and NAFLD need to be better delineated. Also, although the mechanisms of the promotional effect of cholecystectomy on NAFLD development are unknown, recent findings unveiling new aspects of gallbladder physiology and endocrine actions of bile acids provide a framework to advance research in this field., Summary: In this review, we address the different aspects of the complex association between NAFLD and GSD. The potential underlying mechanisms and recent information on endocrine actions of bile acids and the gallbladder are reviewed.

Purpose of Review: Gallstone disease is a major epidemiologic and economic burden worldwide, and the most frequent form is cholesterol gallstone disease., Recent Findings: Major pathogenetic factors for cholesterol gallstones include a genetic background, hepatic hypersecretion of cholesterol, and supersaturated bile which give life to precipitating cholesterol crystals that accumulate and grow in a sluggish gallbladder. Additional factors include mucin and inflammatory changes in the gallbladder, slow intestinal motility, increased intestinal absorption of cholesterol, and altered gut microbiota. Mechanisms of disease are linked with insulin resistance, obesity, the metabolic syndrome, and type 2 diabetes. The role of nuclear receptors, signaling pathways, gut microbiota, and epigenome are being actively investigated., Summary: Ongoing research on cholesterol gallstone disease is intensively investigating several pathogenic mechanisms, associated metabolic disorders, new therapeutic approaches, and novel strategies for primary prevention, including lifestyles.

The aim of this study was to determine the association between nonalcoholic fatty liver disease (NAFLD) and asymptomatic gallstones in a Chinese population.The study had a cross-sectional design and enrolled 7583 subjects who visited the physical check-up center at Sir Run Run Shaw Hospital between 2009 and 2011. Colorimetric methods were used to measure the levels of cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), whereas fasting plasma glucose (FPG) level was measured using a dextrose-oxidizing enzyme method. Subjects who completed a questionnaire and underwent a medical and ultrasound examinations were included in the study.The prevalence of NAFLD was significantly higher in patients with asymptomatic gallstones than in those without asymptomatic gallstones (58.98% vs 46.58%, respectively; P < .0001). The age-adjusted odds ratio (OR) for NAFLD being accompanied by asymptomatic gallstones was 1.35 [95% confidence interval (CI), 1.13-1.61; P = .0009] in male and 1.92 (95% CI, 1.45-2.54; P < .0001) in female subjects. Asymptomatic gallstones were associated with NAFLD in subjects aged < 50 years (OR = 1.74, 95% CI, 1.44-2.12; P < .0001), but not in subjects aged > 50 years (OR = 1.17, 95% CI, 0.92-1.48; P = .2040). The OR of NAFLD for asymptomatic gallstones was 1.28 after multivariate logistic regression analysis (95% CI, 1.07-1.52; P = .006).Our results indicated that asymptomatic gallstones are strongly associated with NAFLD in the Chinese study population.

Objectives: Unraveling pathogenesis of gallstones could help to diminish its enormous disease burden. We hypothesized that certain properties of childhood cholesterol metabolism predict gallstone disease in adulthood., Methods: Childhood serum cholestanol and plant sterols (surrogates for cholesterol absorption), cholesterol precursors (surrogates for cholesterol synthesis), lipids, demographics, and dietary habits were compared between individuals diagnosed with gallstone disease subsequently in adulthood (n = 95) and control subjects (n = 190) matched for age, sex, and body mass index in 1980. Subjects were participants of prospective Cardiovascular Risk in Young Finns Study., Results: In 1980, at mean age of 11.4 years gallstone cohort was characterized by 5.8% lower cholestanol (P = 0.038), and 11.2% to 12.2% (P range = 0.003-0.008) lower plant sterols campesterol, sitosterol, and avenasterol compared with controls. Mean lathosterol/sitosterol ratio was 16.3% higher in gallstone compared with control cohort (P = 0.028). Female gallstone group had 5.4% lower mean cholestanol compared with controls (P < 0.05), and, respectively, those of campesterol, sitosterol, and avenasterol were 12.7% to 14.0% lower (P < 0.05 for each). Body mass index was inversely related to cholestanol and sitosterol (r range = -0.161 to -0.208, P < 0.05 for each) in controls, but not among patients with gallstone. In whole study population, surrogates of cholesterol absorption (eg, campesterol, P = 0.018) and low dietary intake of vegetables (P = 0.009) were significant predictors of gallstones in logistic regression model., Conclusions: Cholesterol metabolism trait characterized by low serum levels of surrogate markers of cholesterol absorption precedes adult gallstone disease already in childhood. Low serum cholestanol and plant sterol ratios during normal Western diet may have role as predictive biomarkers for gallstones.

The introduction of endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ES) has changed the treatment of choledocholithiasis. An increasing number of young patients are requiring ES, and this raises concern regarding any potential long-term complications arising from irreversibly altering the anatomy of the sphincter of Oddi. In particular, concern has been raised regarding the risk of late cholangiocarcioma. A review was performed evaluating the relationship between ES for benign disease and the subsequent development of late complications, including biliary tract malignancy, the formation of primary duct stones, and recurring cholangitis. A systematic review of articles published between 1970 and 2013 was undertaken. Current evidence shows that ES is a safe and effective treatment for common bile duct stones. The long-term risk of subsequent cholangiocarcinoma has not been convincingly proven although in many of these studies the follow-up period was inadequate. There does appear to be an associated increased incidence of cholangiocarcinomas following sphincterotomy although this is not proven to be causative. If there is an increased risk of cholangiocarcinoma following ES, it is likely to be small in western populations. However, until longer follow-up studies are published, it may be prudent to avoid ES in the very young.

Purpose: To determine risk factors for the development of gallstones and the prevalence of related cholecystectomy in children following hematopoietic cell transplantation (HCT)., Patients and Methods: A retrospective chart review of 1343 patients aged below 18 years old who survived at least 1 year after HCT from 1969 to 2011 was performed. Multivariate Cox regression models were used to estimate the hazard ratio (HR) of risk factors associated with gallstones., Results: Gallstones developed in 91 patients, a median of 3.5 (range, 0.1 to 30.9) years after HCT at 16.3 (range, 0.8 to 44.2) years of age, with a 40-year cumulative incidence of 11%. At initial diagnosis, 61 (67%) patients were symptomatic and 30 (23%) had incidental gallstones. Risk factors associated with gallstones included autologous transplant (HR=2.7, P=0.02), unrelated donor (HR=2.0, P=0.05), grade 3 to 4 acute graft-versus-host disease (GVHD) (HR=2.2, P=0.03), chronic GVHD (HR=2.0, P=0.05), second transplant (HR=2.3, P=0.03), diabetes (HR=2.2, P=0.05), and estrogen therapy (HR=1.8, P=0.03). Fifty-six patients underwent cholecystectomy. The prevalence of cholecystectomy among 853 surviving patients was 5.2%., Conclusions: Childhood HCT patients have an increased risk of developing gallstones.

Complications due to retained gallstones after a laparoscopic cholecystectomy occur in 1.7 per 1000 cases. Significant delay to definitive diagnosis and treatment is common due to late presentation and nonspecific symptoms. Despite the low frequency, complications due to retained gallstones may be serious, including abscess and fistula formation. In the present case, we discuss the removal of abdominal wall and peritoneal stones 8 months after the original laparoscopic cholecystectomy. The case illustrates that complications may arise months to years after the original procedure and requires a high degree of clinical suspicion for expeditious diagnosis. Ultrasound is a sensitive and specific test to identify retained stones. Laparoscopic retrieval is recommended upon identification of intraperitoneal stones within this timeline.

Objectives: The aims of this study were to correlate the temporal trends in obesity prevalence with hospitalization rates for symptomatic cholelithiasis and to estimate the strength of the association between obesity and symptomatic cholelithiasis in patients hospitalized at an urban children's hospital in New York serving a multiethnic population., Methods: Using obesity prevalence data from the National Health and Nutrition Examination Survey and the rates of hospitalization for cholelithiasis derived from the Kids' Inpatient Database for 1997-2007, we estimated a correlation and a linear regression. We conducted a retrospective, case-control study in which each case ages 4 to 20 years with symptomatic cholelithiasis was individually matched to a control admitted with appendicitis based on age, sex, ethnicity, and race., Results: The prevalence of obesity and the cholelithiasis hospitalization rate increased over time (R=0.87, P=0.0025). For every 1% increase in the obesity rate among children, the rate of hospitalization for gallstones increased by 0.65/100,000 children (R²=0.75, P=0.0025, 95% confidence interval [CI] 0.32-0.99). The odds ratio for obesity in cases versus controls was 5.78 (n=518, P<0.0001, 95% CI 3.50-9.53). We found a significant dose-response effect, which showed that for every 1 z score increase in body mass index, the risk of cholelithiasis was increased by 79% (P<0.0001, 95% CI 1.5-2.13)., Conclusions: The national trend in the prevalence of obesity from 1997 to 2009 was significantly correlated with increasing rates of hospitalization for pediatric cholelithiasis. Our case-control study suggests that obesity is a significant risk factor for hospital admission because of cholelithiasis.

Obesity is the major risk factor in cholesterol crystal and gallstone formation. After an Roux-en-Y gastric bypass, biliary duct dilatation can appear and gallstone formation can cause biliary duct obstruction or gallstone pancreatitis. Management of this clinical situation can be challenging and many approaches have been reported. Endoscopic retrograde cholangiopancreatography plays an important role in the management of biliary duct obstruction in these patients. However, a previous modified anatomy makes this procedure technically difficult. For these reason, we describe our single-institution experience in the management of biliary duct obstruction utilizing a hybrid approach combining laparoscopy and flexible endoscopy.

Objectives: The aim of the present study was to investigate the association between childhood and adolescent obesity, the risk of gallstones, and the potential effect modification by oral contraceptive use in girls., Methods: For this population-based cross-sectional study, measured weight and height, oral contraceptive use, and diagnosis of cholelithiasis or choledocholithiasis were extracted from the electronic medical records of 510,816 patients ages 10 to 19 years enrolled in an integrated health plan, 2007-2009., Results: We identified 766 patients with gallstones. The adjusted odds ratios (95% CI) of gallstones for under-/normal-weight (reference), overweight, moderate obesity, and extreme obesity in boys were 1.00, 1.46 (0.94%-2.27%), 1.83 (1.17%-2.85%), and 3.10 (1.99%-4.83%) and in girls were 1.00, 2.73 (2.18%-3.42%), 5.75 (4.62%-7.17%), and 7.71 (6.13%-9.71%), respectively (P for interaction sex × weight class <0.001). Among girls, oral contraceptive use was associated with higher odds for gallstones (odds ratio 2.00, 95% CI 1.66%-2.40%). Girls who used oral contraceptives were at higher odds for gallstones than their counterparts in the same weight class who did not use oral contraceptives (P for interaction weight class × oral contraceptive use 0.023)., Conclusions: Due to the shift toward extreme childhood obesity, especially in minority children, pediatricians can expect to face increasing numbers of children and adolescents affected by gallstone disease.

Colonic gallstone ileus is an unusual cause of colonic obstruction. Management of these patients is not standardized and can be challenging. As these patients are often ill and frail at presentation, surgical management needs to be individualized to decrease morbidity and mortality. We report a case that was managed by staged minimally invasive techniques with an excellent outcome.

Childhood overweight and obesity are major health problems with immediate and long-term consequences of staggering magnitude. Despite this, there are few preventive and therapeutic strategies of proven effectiveness available to public health and clinical practitioners. Accruing such evidence is currently and appropriately a health policy priority, but there is an urgent need to intervene even before comprehensive solutions are fully established. The aim of this Clinical Report on Overweight Children and Adolescents is to present information on current understanding of pathogenesis and treatment of overweight and obesity. We report on the epidemiology, molecular biology and medical conditions associated with overweight; on dietary, exercise, behavioral, pharmacological and surgical treatments; and on the primary prevention of overweight in children and adolescents.

Objective: The aim of this study was to investigate gallbladder motility in children with Down syndrome by measuring gall-bladder volume and contraction index., Methods: This study, performed between January 2001 and December 2002 at the Ondokuz Mayis University, School of Medicine, Department of Paediatric Neurology, Samsun, Turkey, included 21 patients with Down syndrome (study group) and 22 healthy children (control group). After an 8-hour fast, gallbladder diameters in both groups were measured in length, width, and height by ultrasonography before and 30 minutes after a test meal. The volume of gallbladder before and after a test meal was determined, and the contraction index was calculated. Blood triglyceride and cholesterol levels were measured, and 5-hydroxyindoleacetic acid (5-HIAA) levels in urine were determined., Results: Mean gallbladder volume before test meal in the study group and controls was 8,412.4 +/- 5,174 mm and 16,516.8 +/- 6,796.1 mm (P < 0.001), respectively. The mean contraction index of the study group was 41.2% +/- 19.4% and of controls, 75.0% +/- 12.3% (P < 0.001). The mean triglyceride level of the study group was significantly higher than controls (P < 0.05). The mean urine 5-HIAA level of the study group was lower than controls (P < 0.05)., Conclusion: CI was lower in patients with Down syndrome, suggesting gallbladder hypomotility. Hypomotility may be a feature associated with the high prevalence of gallstones in Down syndrome.

Objective: The authors report their experience with biliary tract stones in adult and pediatric heart transplant patients, and review the current literature relative to this problem., Summary Background Data: Prior studies in adults have noted that heart transplant patients frequently have cholelithiasis, but offer no consensus about treatment strategy. Few studies exist for pediatric heart transplant patients. A higher rate of hemolysis and cyclosporine-induced changes in bile metabolism may contribute to lithogenesis in this population., Methods: A chart review was conducted for 211 patients who had heart transplants between January 1988 and September 1994 to determine prevalence of biliary tract stones, management strategies used, and outcome., Results: Of 175 long-term heart transplant survivors, 52 (29.7%) had stones detected: 32.8% of adults (47/143) and 15.6% of children (5/32). The majority of patients (31) were diagnosed 4 months (mean) after transplantation; cholelithiasis developed in 10 of these patients (32%) within 11 months (median) after a negative ultrasound. Symptoms developed in 45% of patients. All patients underwent either elective (36) or urgent (6) cholecystectomy via an open (32) or laparoscopic (10) approach, or endoscopy for common bile duct stones (2). There were no deaths or complications during a follow-up period of up to 7 years., Conclusion: Heart transplant patients have a high prevalence of symptomatic biliary tract stone disease. They can be treated safely via an open or laparoscopic approach after transplantation. The authors recommend routine gallbladder ultrasound screening and elective cholecystectomy in the post-transplant period if stones are detected.