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Abstract
Background/Aims
The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer.
Methods
Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer.
Results
A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p<0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase.
References
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Fig. 1.
Measurement of the common bile duct on abdominal computed tomography. (A) Proximal common bile duct in the porta hepatis. (B) Distal common bile duct in the pancreas head.
Table 1.
Baseline Characteristics and Liver Function Tests
Table 2.
Incidence of Cholelithiasis between Two Groups
| Group | Cholelithiasis | No cholelithiasis | p-value |
|---|---|---|---|
| Operation group | 47 (6.39) | 688 (93.61) | 0.7909 |
| Control group | 3 (4.48) | 64 (95.52) |
Table 3.
Relationship between Incidence of Cholelithiasis and Post-operative Duration
| Duration (mo) | Operation group | Control group | p-value |
|---|---|---|---|
| 0–6 | 13 (27.66) | 0 | 0.7438 |
| 7–12 | 2 (4.26) | 0 | |
| 13–24 | 4 (8.51) | 0 | |
| 25- | 28 (59.57) | 3 (100) | |
| Total | 47 (100) | 3 (100) |
Table 4.
Incidence of Cholelithiasis according to the Operation Method
Table 5.
Degree Categorization for Change of Common Bile Duct Diameter
Table 6.
Analysis for Change of Common Bile Duct Diameter
Table 7.
Risk of Common Bile Duct Dilatation according to the Laboratory Finding
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