Study Finds Most Gallstones in SCD Reach Advanced Stage Before Treatment

By Patrick Daly - Last Updated: January 29, 2024

Among patients with sickle cell disease (SCD) with cholelithiasis (gallstones), 73% had an “advanced clinical presentation” by the time they underwent a cholecystectomy, according to a study published in the Journal of the American College of Surgeons.

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Notably, “following cholecystectomy, perioperative vaso-occlusive events were significantly increased in patients with advanced clinical presentation,” reported the study’s authors, led by Ahmad Zeineddin, MD, from the Howard University College of Medicine in Washington, DC.

Researchers evaluated 6,662 patients with SCD and cholelithiasis from the Nationwide Inpatient Sample. The cohort had a median age of 20 years (interquartile range, 16-34) and was 65% female. Patients were categorized based on presentation with chronic cholecystitis (44%), uncomplicated cholelithiasis (27%), acute cholecystitis (21%), or gallstone pancreatitis (8%).

Increased Risk of Perioperative Vaso-Occlusive Crisis With Advanced Cholelithiasis

In total, 1,779 patients with SCD underwent cholecystectomy. Multivariable regression analyses indicated that advanced clinical presentation was the strongest predictor of perioperative vaso-occlusive crisis—the most common complication.

Additionally, patients with uncomplicated cholelithiasis had lower risk of complications compared with acute cholecystitis (odds ratio [OR], 2.37; 95% CI, 1.64-3.41), chronic cholecystitis (OR, 1.74; 95% CI, 1.26-2.4), and choledocholithiasis or gallstone pancreatitis (OR, 2.24; 95% CI, 1.41-3.57).

Ultimately, “these data support screening abdominal ultrasounds and early cholecystectomy for cholelithiasis in patients with SCD,” suggested Dr. Zeineddin and colleagues.

Reference

Zeineddin A, Cornwell Iii EE, Fullum TM, et al. Early cholecystectomy in sickle cell patients with uncomplicated cholelithiasis is associated with better outcomes. J Am Coll Surg. 2024. doi:10.1097/XCS.0000000000000949

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