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Multicenter Study
. 2024 Apr;12(3):286-298.
doi: 10.1002/ueg2.12544. Epub 2024 Feb 20.

Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study

Raúl Velamazán  1   2   3 , Pablo López-Guillén  4   5 , Samuel J Martínez-Domínguez  1   3 , Daniel Abad Baroja  3   6 , Daniel Oyón  7   8 , Anna Arnau  9   10   11 , Lara M Ruiz-Belmonte  12 , Javier Tejedor-Tejada  13 , Raul Zapater  14 , Noelia Martín-Vicente  7 , Pedro José Fernández-Esparcia  15 , Ana Belén Julián Gomara  5 , Violeta Sastre Lozano  16 , Juan José Manzanares García  16 , Irene Chivato Martín-Falquina  17 , Laura Andrés Pascual  17 , Nuria Torres Monclus  18 , Natividad Zaragoza Velasco  18 , Eukene Rojo  19   20 , Berta Lapeña-Muñoz  21 , Virginia Flores  22 , Arantxa Díaz Gómez  22 , Pablo Cañamares-Orbís  3   23 , Isabel Vinzo Abizanda  24 , Natalia Marcos Carrasco  14 , Laura Pardo Grau  25 , Guillermo García-Rayado  1   3 , Judith Millastre Bocos  1   3 , Ana Garcia Garcia de Paredes  14   26   27   28 , María Vaamonde Lorenzo  29 , Arantzazu Izagirre Arostegi  29 , Edgard Efrén Lozada-Hernández  30 , José Antonio Velarde-Ruiz Velasco  31 , Enrique de-Madaria  4   5
Affiliations
Multicenter Study

Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study

Raúl Velamazán et al. United European Gastroenterol J. 2024 Apr.

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.

Keywords: biliary colic; biliary pain; cholangitis; cholecystectomy; cholecystitis; cholelithiasis; gallstones; pancreatitis; recurrences; relapse.

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Conflict of interest statement

All the authors confirm no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves for the probability of relapse during 24 months after the first episode of gallstone‐related disease in the overall sample and according to the different types of gallstone disease.
FIGURE 2
FIGURE 2
Kaplan‐Meier survival curves for the probability of relapse during follow‐up after discharge according to independent prognostic factors of multivariable analysis.
See this image and copyright information in PMC

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