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

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.