Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 276-282
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.276
Morphologic factors of biliary trees are associated with gallstone-related biliary events
Jin-Seok Park, Don Haeng Lee, Jun Hyeok Lim, Seok Jeong, Young Sun Jeon
Jin-Seok Park, Don Haeng Lee, Jun Hyeok Lim, Seok Jeong, Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Incheon 400-711, South Korea
Young Sun Jeon, Department of Radiology, Inha University School of Medicine, Incheon 400-711, South Korea
Author contributions: Park JS and Lee DH conceived of and designed the study; Park JS, Lee DH and Lim JH collected and assembled the data; Park JS and Jeong S provided study materials and patients; Park JS and Jeon YS analyzed and interpreted the data; Park JS drafted the article; and Lee DH critically revised and approved the final version of the manuscript.
Supported by A research grant from Inha University
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Don Haeng Lee, MD, PhD, Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, 7-206, 3-GA, Sinheung-Dong, Jung-Gu, Incheon 400-711, South Korea. ldh@inha.ac.kr
Telephone: +82-32-8902548 Fax: +82-32-8902549
Received: March 26, 2014
Peer-review started: March 27, 2014
First decision: May 29, 2014
Revised: June 7, 2014
Accepted: July 15, 2014
Article in press: July 16, 2014
Published online: January 7, 2015
Abstract

AIM: To determine the risk factors for gallstone-related biliary events.

METHODS: This retrospective cohort study evaluated magnetic resonance cholangiopancreatography images from 141 symptomatic and 39 asymptomatic gallstone patients who presented at a single tertiary hospital between January 2005 and December 2012.

RESULTS: Logistic regression analysis showed significant differences between symptomatic and asymptomatic patients with gallstones in relation to the number of gallstones, the angle between the long axis of the gallbladder and the cystic duct, and the cystic duct diameter. Multivariate analysis showed that the number of gallstones (OR = 1.27, 95%CI: 1.03-1.57; P = 0.026), the angle between the long axis of the gallbladder and the cystic duct (OR = 1.02, 95%CI: 1.00-1.03; P = 0.015), and the diameter of the cystic duct (OR = 0.819, 95%CI: 0.69-0.97; P = 0.018) were significantly associated with biliary events. The incidence of biliary events was significantly elevated in patients who had the presence of more than two gallstones, an angle of > 92° between the gallbladder and the cystic duct, and a cystic duct diameter < 6 mm.

CONCLUSION: These findings will help guide the treatment of patients with asymptomatic gallstones. Clinicians should closely monitor patients with asymptomatic gallstones who exhibit these characteristics.

Keywords: Cystic duct, Gallbladder, Gallstone disease, Magnetic resonance cholangiopancreatography, Risk factor

Core tip: This is a retrospective cohort study that evaluated magnetic resonance cholangiopancreatography images from 180 patients. We found that the incidence of biliary events was significantly elevated in patients who had more than two gallstones, an angle of > 92° between the gallbladder and the cystic duct, and/or a cystic duct diameter < 6 mm. When considering these factors as a risk factor of gallstone-related biliary events, the positive predictive value for biliary events in patients with all three risk factors was 89.3%.