More Patients With Bariatric Surgery Admitted for Gallstone-Related Biliary Disease Interview with:

Violeta Popov, MD PhD FACG Assistant Professor of Medicine Director of Bariatric Endoscopy, NY VA Harbor Healthcare(Manhattan) Division of Gastroenterology NYU Langone Medical Center 

Dr. Popov

Violeta Popov, MD PhD FACG
Assistant Professor of Medicine
Director of Bariatric Endoscopy, NY VA Harbor Healthcare(Manhattan)
Division of Gastroenterology
NYU Langone Medical Center What is the background for this study? What are the main findings? 

Response: Bariatric surgery is the most effective method currently available for durable weight loss. In the first few months after surgery, patients typically experience significant weight loss. Rapid weight reduction though can lead to the development of gallstones and biliary disease, described in up to 40% of post-bariatric patients. To avoid these complications, the gallbladder was removed during open bariatric procedures in the past. However, with the advent of laparoscopic surgery, concomitant cholecystectomy with bariatric surgery is no longer performed for many reasons.  The aim of is study is to assess if biliary diseases such as acute pancreatitis, acute cholecystitis, acute cholangitis, and cholecystectomy have increased with this change in practice. This is a retrospective cohort analysis of the National Inpatient Sample (NIS), the largest publicly available inpatient database in the United States of nonfederal institutions, with approximately 1000 hospitals participating and information on over 7 million inpatient admissions.

We found that from 2006 to 2014 there has been an approximately 10-fold increase in hospital admissions for biliary diseases, as well as similar increase in cholecystectomies, in patients who have a history of bariatric surgery. There was no significant change in admissions in patients without bariatric surgery between 2006 and 2014 admitted for the same biliary diseases. What should readers take away from your report?

Response: Our study found a significant increase over the past decade in hospitalizations for acute cholecystitis, acute cholangitis, acute pancreatitis and cholecystectomies in patients who have undergone bariatric surgery. Both physicians and patients should be aware of this increased risk. In the appropriate clinical scenario, physicians should have a low threshold to initiate appropriate treatment, especially if the patient has not undergone a cholecystectomy already. Remind your patients with recent bariatric surgery to take prophylactic medications to decrease the risk of gallstone formation. What recommendations do you have for future research as a result of this work?

Response: Our team used a retrospective study design based on coding records, with possible errors due to incorrect coding, and increase over time in the total number of patients with prior bariatric surgery. To more accurately assess this trend, prospective cohort studies of bariatric surgery patients are needed. Retrospective studies of individual centers comparing gallstone-related disease in bariatric patients who had or not had cholecystectomies could also be valuable. Laparoscopic surgery is safer for patients overall. Further research in medical or surgical interventions that could potentially decrease the risk of gallstone formation is needed. Is there anything else you would like to add?

Response: I would like to add that ,nevertheless, bariatric surgery is a safe and very effective method to lose weight. Although we noted an increase in biliary disease, this should not discourage patients from undergoing bariatric surgery. Overall, the frequency of these complications is very low, and we have effective methods to treat them if they do develop. 

Citation: ACG2018Presidential Poster Award 

Biliary Disease Has Increased in Patients with Bariatric Surgery Over the Past Decade: A Nationwide Analysis

Andrew Thompson1, Violeta Popov, MD, PhD2

Oct 10, 2018 @ 11:44 am

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