Increased risk of cholelithiasis after esophagectomy.
OBJECTIVE
Truncal vagotomy enhances gallstone formation. As esophagectomy involves truncal vagotomy, it was hypothesized that esophagectomy would increase the risk of cholelithiasis. This study was intended to test this hypothesis and to elucidate factors influencing the incidence of cholelithiasis after esophagectomy.


METHODS
The study was a retrospective analysis of 136 patients with esophageal carcinoma who had survived for 5 years or longer after esophagectomy. Eight patients (5.9%) had cholelithiasis before esophagectomy. Of the remaining 128 patients, 113 underwent abdominal ultrasonographic examination for cholelithiasis twice a year after esophagectomy; the median follow-up time was 89.5 months (range, 60-117 months).


RESULTS
Gallstones developed in 26 (23%) of the 113 patients undergoing regular ultrasonographic examination. The cumulative incidence of cholelithiasis reached a plateau of 34% at 10 years after esophagectomy. Reduction of body mass index after esophagectomy was the strongest independent predictor of gallstone formation after esophagectomy ( P = 0.0001, log-rank test; P = 0.0003, Cox's proportional hazards model). The prevalence of cholelithiasis at 5 years after esophagectomy (18/113; 16%) was significantly higher than that before esophagectomy (8/136; 5.9%; P = 0.012, Fisher's exact test).


CONCLUSIONS
Esophagectomy yields an increased risk of the development of cholelithiasis. Truncal vagotomy and postsurgical malnutrition may contribute to this increased gallstone formation after esophagectomy.
Tsunoda
Kazuhiko
K
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, 951-8510, Niigata, Japan.
Shirai
Yoshio
Y
Wakai
Toshifumi
T
Yokoyama
Naoyuki
N
Akazawa
Kohei
K
Hatakeyama
Katsuyoshi
K
D015992:Body Mass Index; D041761:Cholecystolithiasis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005704:Gallbladder / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015167:Vagotomy, Truncal / Q000009:adverse effects*