*EMBARGOED All research presented at the 2018 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 8, 2018, at 8:00 am EDT.
P1610 Biliary Disease Has Increased in Patients with Bariatric Surgery Over the Past Decade: A Nationwide Analysis
Author Insight from Andrew Thompson, Violeta B. Popov, MD, PhD, FACG, NYU School of Medicine
What’s new here and important for clinicians?
Rapid weight loss after bariatric surgery is associated with the development of gallstones and increases the risk of biliary disease. Our study shows that from 2006 to 2014 there has been a 10-fold increase in hospital admissions for acute pancreatitis, cholangitis and acute cholecystitis, as well as a similar increase in cholecystectomies, in patients who have a history of bariatric surgery. There was no change in admissions in patients without bariatric surgery. One explanation is change in surgical practices: the gallbladder would be removed during open bariatric procedures in the past. However, with the advent of laparoscopic bariatric surgery, cholecystectomies at the time of bariatric procedures are not done anymore, thus potentially leading to increased gallstone-related complications.
Take-home message: Bariatric surgery increases the risk of gallstones and related diseases. In the appropriate clinical scenario, have a low threshold to consider these diagnoses and initiate appropriate treatment, especially if the patient has not undergone a cholecystectomy already. Remind your patients with recent weight-loss surgery to take prophylactic medications to decrease the risk of gallstone formation such as ursodeoxycholic acid.
Future studies and directions: the compelling increase in biliary disease requires further prospective trials. One has to be mindful that this is a retrospectively collected data based on coding records, with possible errors due to the use of a relatively underutilized code (history of bariatric surgery), and increase over time in the total number of subjects with prior weight-loss surgery. New medical and surgical interventions to prevent the significant morbidity associated with gallstone-related diseases in the post-bariatric population are needed.
What do patients need to know?
Weight-loss (bariatric) surgery increases the risk of gallstones and related diseases such as inflammation of the pancreas and gallbladder. Surgeons used to remove the gallbladder at the same time as the weight-loss procedure during an open surgery to prevent these. However, over time surgical procedures have changed to a less-invasive method, laparoscopic surgery. Laparoscopic bariatric surgery is safer overall but makes simultaneous removal of the gallbladder challenging. Nowadays surgeons rarely do both procedures together. Our study shows that from 2006 to 2014 there has been a 10-fold increase in hospital admissions for gallstone-related diseases in patients with history of weight-loss surgery, possibly due to that change in surgical methods. Thus, patients who have had bariatric surgery should be aware of the increased risk and follow their physicians’ advice to prevent gallstones and treat related disease.
Violeta B. Popov, MD, PhD, FACG, NYU School of Medicine
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