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Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study
Ist Teil von
United European gastroenterology journal, 2024-04, Vol.12 (3), p.286-298
Ort / Verlag
England: John Wiley & Sons, Inc
Erscheinungsjahr
2024
Quelle
Wiley Online Library Journals Frontfile Complete
Beschreibungen/Notizen
Background
Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available.
Objective
We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors.
Methods
RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse‐free survival. Kaplan–Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses.
Results
Mean age was 76.6 [IQR: 59.7–84.1], and 51% were male. The median follow‐up was 5.3 months [IQR 2.1–12.4]. Relapse‐free survival was 0.79 (95% CI: 0.77–0.80) at 3 months, 0.71 (95% CI: 0.69–0.73) at 6 months, and 0.63 (95% CI: 0.61–0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49–0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49–0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70–0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02–1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05–1.34) were associated with higher relapse rates.
Conclusion
The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.