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Cholecystectomy and Liver Disease in Short Bowel Syndrome
Jon S. Thompson*, Rebecca a. Weseman, Fedja a. Rochling, Wendy Grant, Luciano Vargas, Alan Langnas, David F. Mercer
University of Nebraska Medical Center, Omaha, NE
Background:
Cholelithiasis and liver disease are common in patients with short bowel syndrome (SBS). Recently an association has been proposed between cholecystectomy and the development of various liver diseases. Our aim was to determine whether cholecystectomy in SBS patients influences the risk of liver disease.
Methods:
We reviewed 412 adults with SBS: 177 underwent cholecystectomy prior to SBS (pre-SBS), 102 after developing SBS (post SBS), either for disease or as a prophylactic cholecystectomy, and 133 patients still had the gallbladder (GB) in place. Follow up ranged from 12 to 456 months. Liver disease was determined by serum liver function tests, radiologic imaging, endoscopic findings and histologic evaluation.
Results:
The groups were similar with respect to age, gender and diagnoses leading to SBS. Compared to pre-SBS and post SBS, GB patients were significantly less likely to have an initial BMI >35 (18% and 19% vs 10%), central line infections (59% and 68% vs 45%), an intestinal remnant <60 cm (28% and 38% vs 24%), require PN>1 year (72% and 78% vs 65%), and undergo surgical rehabilitation (39% and 41% vs 23%). The incidence of fatty liver was similar (30%, 25% and 26%). Fibrosis / cirrhosis was less common in the GB group (28% and 36% vs 16%). However, PN>1 year, central line infection and intestinal remnant <60 cm were the predictive factors of fibrosis/cirrhosis. Frequency of end stage liver disease (ESLD) was similar (14%, 15% and 11%). PN>1 year, central line infection and remnant length <60 cm were predictors of ESLD.
Conclusions:
Cholecystectomy does not appear to increase the incidence of liver disease in SBS patients. While fibrosis/cirrhosis occurs less frequently in patients with an intact gallbladder, there are differences in the patient populations. SBS patients retaining their gallbladder have a lower frequency of risk factors associated with fibrosis/cirrhosis and ESLD.
Key words: Short bowel syndrome; liver disease
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