Risk factors for the development of gallstone recurrence following medicaldissolution

Objective To assess risk factors for gallstone recurrence following non-sur gical treatment. Design A prospective follow-up of a multicentre cohort of post-dissolution gallstone patients. Setting Six gastroenterology units in the UK and Italy. Participants One hundred and sixty-three patients with confirmed gallstone dissolution following non-surgical therapy (bile acids or lithotripsy plus bile acids), followed up by ultrasound scan and clinical assessment at B-mo nthly intervals for up to 6 years (median, 25 months; range, 6-70 months). Outcome measures Subject-related variables (sex, age, height, weight, body mass index), gallstone-related variables (number, diameter, presence of sym ptoms, months to complete stone clearance), treatment modalities (bile acid therapy, extracorporeal shock wave lithotripsy) and follow-up related vari ables (weight change, use of non-steroidal anti-inflammatory agents, statin s, pregnancies and/or use of oestrogens) were assessed by univariate and mu ltivariate analysis as putative risk factors for gallstone recurrence. Results Forty-five gallstone recurrences were observed during the follow-up period. Multiple primary gallstones and length of time to achieve gallston e dissolution were the only variables associated with a significant increas e in the recurrence rate. Appearance of biliary sludge during follow-up was also significantly related to development of gallstone recurrence, Use of statins or non-steroidal antiinflammatory agents did not confer protection against recurrence. Conclusions Patients with primary single stones are the best candidates for non-surgical treatment of gallstones, because of a low risk of gallstone r ecurrence. The positive association of recurrence with biliary sludge forma tion and time to dissolution of primary stones may provide indirect confirm ation for the role of impaired gallbladder motility in the pathogenesis of this condition. (C) 2000 Lippincott Williams & Wilkins.