Presence of small and multiple gallstones increases the risk of biliary complications

Abstract

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion: Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Keywords

• cholangitis
• gallstones
• jaundice, obstructive
• pancreatitis