Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study
Raúl Velamazán, Pablo López‐Guillén, Samuel J. Martínez‐Domínguez, Daniel Abad Baroja, Daniel Oyón, Anna Arnau, Lara Ruiz-Belmonte, Javier Tejedor‐Tejada, Raul Zapater, Noelia Martín‐Vicente, Pedro José Fernández‐Esparcia, Ana Belén Julián Gomara, Violeta Sastre Lozano, Juan José Manzanares García, Irene Chivato Martín‐Falquina, Laura Andrés Pascual, Nuria Torres Monclus, Natividad Zaragoza Velasco, Eukene Rojo, Berta Lapeña‐Muñoz, Virginia Flores, Arantxa Díaz Gómez, Pablo Cañamares‐Orbís, Isabel Vinzo Abizanda, Natalia Marcos Carrasco, Laura Pardo Grau, Guillermo García‐Rayado, Judith Millastre Bocos, Ana García García de Paredes, María Vaamonde Lorenzo, Arantzazu Izagirre Arostegi, Edgard Efrén Lozada Hernández, J.A. Velarde-Ruiz Velasco, Enrique de‐Madaria
Abstract
BACKGROUND: Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available. OBJECTIVE: We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors. METHODS: RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses. RESULTS: Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3 months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3 months, 0.71 (95% CI: 0.69-0.73) at 6 months, and 0.63 (95% CI: 0.61-0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49-0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates. CONCLUSION: The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.