Korean J Gastroenterol.  2015 Jul;66(1):33-40. 10.4166/kjg.2015.66.1.33.

Clinical Significance of Biliary Dilatation and Cholelithiasis after Subtotal Gastrectomy

• Yoon H
• Kwon CI
• Jeong S
• Lee TH
• Han JH
• Song TJ
• Hwang JC
• Kim DJ

• KMID: 2373309
• DOI: http://doi.org/10.4166/kjg.2015.66.1.33

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.
CONCLUSIONS
The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.

Keyword

Common bile duct; Biliary tract; Cholelithiasis; Gastrectomy; Stomach neoplasms

MeSH Terms

Aged
Alanine Transaminase/analysis
Aspartate Aminotransferases/analysis
Bilirubin/analysis
Case-Control Studies
Cholelithiasis/*diagnosis/epidemiology
Common Bile Duct/diagnostic imaging/*physiopathology
Endoscopy, Gastrointestinal
Female
Follow-Up Studies
Gastrectomy
Humans
Incidence
Male
Middle Aged
Odds Ratio
Stomach Neoplasms/*surgery
Tertiary Care Centers
Tomography, X-Ray Computed
Aspartate Aminotransferases
Alanine Transaminase
Bilirubin

Figure

• 

  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.

Reference

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