SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Jean-Marie PERON
Coup de coeur :
 
 
Gastroenterology
  2015/09  
 
  2015 Sep. pii: S0016-5085(15)01308-6  
  doi: 10.1053/j.gastro.2015.09.002  
 
  A Prediction Rule for Risk Stratification of Incidentally Discovered Gallstones: Results From a Large Cohort Study  
 
  Shabanzadeh DM, Sørensen LT, Jørgensen T  
  http://www.gastrojournal.org/article/S0016-5085%2815%2901308-6/abstract  
 
 

Background & Aims
No one knows exactly what proportion of gallstones cause clinical events among subjects unaware of their gallstone status. We investigated the long-term occurrence of clinical events of gallstones and associations between ultrasound observations and clinical events.

Methods
We analyzed data from 3 randomly selected groups in the general population of urban Copenhagen (30–70 y old) participating in an international study of cardiovascular risk factors (the MONICA study). In this study, participants (n=6037) were examined from 1982 through 1994, and underwent abdominal ultrasound examinations to detect gallstones. Our study population comprised 664 subjects with gallstones; subjects were not informed of gallstone status. Participants were followed for clinical events through central registers until December 31, 2011. Independent variables included ultrasound characteristics, age, sex, co-morbidity, and female-associated factors, which were analyzed using Cox regression.

Results
Study participants were followed for median 17.4 y (range, 0.1–29.1 y); 99.7% of participants completed the study. A total of 19.6% participants developed events (8.0% complicated and 11.6% uncomplicated). Ten percent had awareness of their gallstones; awareness was associated with uncomplicated and complicated events. Stones larger than 10 mm were associated with all events (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.45–3.69), acute cholecystitis (HR, 9.49; 95% CI, 2.05–43.92), and uncomplicated events (HR, 2.55; 95% CI, 1.38−4.71), including cholecystectomy (HR, 2.69; 95% CI, 1.29–5.60). Multiple stones were associated with all events ([HR, 1.68; 95% CI, 1.00–2.81), complicated events (HR, 2.52; 95% CI, 1.05−6.04), and common bile duct stones (HR, 11.83; 95% CI, 1.54−91). There was an association between gallstones more than 5 y old and acute cholecystitis. Female sex was associated with all and uncomplicated events. We found a negative association between participants’ age and all events, uncomplicated events, and acute cholecystitis. Co-morbidities and female-associated factors (intake of birth control pills or estrogens and number of births) were not associated with events. Compared with men with a single stone of ≤10 mm (reference), women with multiple stones >10 mm had the highest risk for events (HR, 11.05; 95% CI, 3.76–32.44; unadjusted absolute risk, 0.0235 events/person years).

Conclusions
Fewer than 20% of subjects with gallstones develop clinical events. Larger, multiple, and older gallstones are associated with events. Further studies are needed to confirm the prediction rules.

 
Question posée
 
Quel est le devenir d’un patient asymptomatique présentant une maladie lithiasique ?
 
Question posée
 
La grande majorité reste asymptomatique. < 20 % seront symptomatique sur un suivi médian de 17 ans ! La taille, le nombre et l’ancienneté des calculs sont les facteurs prédictifs de symptômes.
 
Commentaires

Une étude que seuls les Danois peuvent faire et qui confirme la prise en charge habituelle en France de la maladie lithiasique.

 
www.snfge.org