The natural history of gallstones: The GREPCO experience

Abstract

During the cross-sectional studies (February 1981 to July 1984) performed by the Group for Epidemiology and Prevention of Cholelithiasis (GREPCO) in Rome, Italy, 161 subjects were identified as having gallstones. Ten subjects did not participate in the prospective follow-up. At entry, 33 of the 151 remaining subjects were symptomatic, and 118 were asymptomatic. Data on incidence of biliary colics, complications, cholecystectomy, and death were collected at least every 2 years. In the initially asymptomatic group, the cumulative probability (% +/- SE) of developing biliary colic was 11.9 +/- 3.0 at 2 years, 16.5 +/- 3.5 at 4 years, and 25.8 +/- 4.6 at 10 years. None of the variables considered as possible modifiers of the natural history were found to be associated with an increased risk of developing biliary colic. The cumulative probability (% +/- SE) of developing complications after 10 years was 3.0 +/- 1.8 in the initially asymptomatic group and 6.5 +/- 4.4 in the symptomatic group (P = NS). Incidence of cholecystectomy was higher in the initially symptomatic than in the asymptomatic group (log-rank test = 2.27; P = .02). Fifteen (53.6%) of the 28 operated in the initially asymptomatic group were submitted to cholecystectomy, although specific symptoms did not occur. Twelve (10.2%) and 2 (6.1%) of the initially asymptomatic and symptomatic subjects died during the follow-up. One patient in the former group died at age 64 of a histologically proven adenocarcinoma of the gallbladder. In conclusion, this study demonstrates that the natural history of gallstones is less benign than is generally considered.

Are histological alterations observed in the gallbladder precancerous lesions?

“…However, the GREPCO Group35 in Italy performed follow-up on 118 patients with asymptomatic gallstones for 10 years, with one occurrence of cancer (0.8%) in a patient who died as a result of this disease at the age of 64.…”

The Risk Paradox: Use of Elective Cholecystectomy in Older Patients Is Independent of Their Risk of Developing Complications

“…1,2 Left untreated, approximately 1-4% of patients per year will develop symptoms due to their gallstones. 3-11 Once symptoms occur, approximately 14% will develop acute cholecystitis, 5% will develop gallstone pancreatitis, and 5% will develop common duct stones within a year. 12 …”

Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones

“…About 5-25 per cent of the adult Western population have gallstones 1 -4 . Some 2-4 per cent become symptomatic each year 4,5 . Cholecystectomy is the preferred treatment option for symptomatic gallstones 6 .…”