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P706 The long-term risk of complicated gallstone disease necessitating cholecystectomy after ileal resection in Crohn’s disease patients

J. C. Goet*1, B. E. Hansen1, K. Bierman2, A. Gijsbers3, C. J. van der Woude1, W. R. Schouten4, H. R. van Buuren1, A.C. de Vries1

1Erasmus MC, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2Erasmus MC, Pathology, Rotterdam, Netherlands, 3PALGA, Rotterdam, Netherlands, 4Erasmus MC, Surgery, Rotterdam, Netherlands

Background

Crohn’s disease (CD) patients are at a 2-fold increased relative risk of gallstones. Ileal resection may play an important pathogenetic role in the development of gallstones. However, the absolute risk of complicated gallstone disease necessitating cholecystectomy after ileal resection in CD patients is unknown. Therefore, we aimed to assess the risk of complicated gallstone disease necessitating cholecystectomy in CD patients after ileal or ileocecal resection.

Methods

CD patients aged ≥ 18 years at ileal or ileocecal resection (ILR) in the period from 1991 to 2014 were identified in PALGA, a nationwide archive containing all pathology reports in the Netherlands. Patients with a history of cholecystectomy were excluded. Details on subsequent ileal resections and cholecystectomy were recorded. Follow-up data were evaluated until December 2014. Risk factors for cholecystectomy during follow-up were evaluated in a Cox regression analysis.

Results

A cohort of 5.553 CD patients (2.219/3.334, M/F) was identified, and underwent ILR at a median age of 37.0 years (37.0/36.0 yr). In total, 291 (5.2%) patients (66/225 M/F) underwent a cholecystectomy after a median interval between ILR and cholecystectomy of 7.27 years. The absolute annual risk of a cholecystectomy after ILR was 0.4% within 1 year, 2.0% within 5 years and 3.3% within 10 years, and 4.5% within 15-years of follow-up.

After initial ILR, 514 (9.3%) patients underwent one or more subsequent ILRs. In multivariate analysis, risk factors for cholecystectomy were female sex (HR 1.25) and more than one ileal resection (HR 1.39).

Figure 1. Cholecystectomy risk after ileal resection.

Conclusion

The absolute risk of cholecystectomy after ileal resection in CD patients is approximately 0.3% per year, and does not warrant routine synchronous prophylactic cholecystectomy during ileal resection.