title: Clinical Significance of Biliary Dilatation and Cholelithiasis after Subtotal Gastrectomy.
abstract: OBJECTIVE
  The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer.
  
  
  METHODS
  Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer.
  
  
  RESULTS
  A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase.
  
  
  CONCLUSIONS
  The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.
authors.affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Harry
authors.initials: H
authors.lastname: Yoon
authors.affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Chang Il
authors.initials: CI
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Joung Ho
authors.initials: JH
authors.lastname: Han
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Dae Jung
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000032:analysis; D001663:Bilirubin / Q000032:analysis; D016022:Case-Control Studies; D002769:Cholelithiasis / Q000175:diagnosis* / Q000453:epidemiology; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013274:Stomach Neoplasms / Q000601:surgery*; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: Biliary tract; Cholelithiasis; Common bile duct; Gastrectomy; Stomach neoplasms