Open AccessRates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit
Author(s) -
Farrugia Alexia,
Attard Joseph Anthony,
Hanmer Stuart,
Bullock Stuart,
McKay Siobhan,
AlAzzawi Marwa,
Ali Roshneen,
BondSmith Giles,
Colleypriest Ben,
Dyer Sarah,
Masterman Benjamin,
Okocha Michael,
Osborne Alan,
Patel Rikhilroy,
Sallam Mahmoud,
Selveraj Emmanuel,
Shalaby Samar,
Sun Wenrui,
Todd Fraser,
Ward Joel,
Windle Rebecca,
Khan Saboor,
Williams Nigel,
Arasaradnam Ramesh P.
Publication year - 2021
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-021-06147-8
Subject(s) - medicine , cholecystectomy , bile acid , abdominal surgery , demographics , enterohepatic circulation , diarrhea , general surgery , retrospective cohort study , gallbladder , gastroenterology , laparoscopic cholecystectomy , endoscopy , demography , sociology
Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post‐cholecystectomy diarrhoea has been reported in 2.1–57.2% of patients; however, this is not necessarily due to BAD. The aim of this study was to determine the rates of bile acid diarrhoea diagnosis after cholecystectomy and to consider investigation practices. Methods A retrospective analysis of electronic databases from five large centres detailing patients who underwent laparoscopic cholecystectomy between 2013 and 2017 was cross‐referenced with a list of patients who underwent 75 SeHCAT testing. A 7‐day retention time of <15% was deemed to be positive. Patient demographics and time from surgery to investigation were collected and compared for significance ( p < 0.05). Results A total of 9439 patients underwent a laparoscopic cholecystectomy between 1 January 2013 and 31 December 2017 in the five centres. In total, 202 patients (2.1%) underwent investigation for diarrhoea via 75 SeHCAT, of which 64 patients (31.6%) had a 75 SeHCAT test result of >15%, while 62.8% of those investigated were diagnosed with bile acid diarrhoea (BAD). In total, 133 (65.8%) patients also underwent endoscopy and 74 (36.6%) patients had a CT scan. Median time from surgery to 75 SeHCAT test was 672 days (SD ± 482 days). Discussion/Conclusion Only a small proportion of patients, post‐cholecystectomy, were investigated for diarrhoea with significant time delay to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher, and clinicians need to have an increased awareness of this condition due to its amenability to treatment. 75 SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.