Adenomas of the large intestine after cholecystectomy.

Abstract

SUMMARY The frequency of adenomas of the large intestine in 331 cholecystectomised patients who underwent total colonoscopy was compared with that of a control group of patients with asymptomatic cholelithiasis who were matched for age and sex. Whereas no significant difference in the frequency of adenomas was found between these two groups, a subgroup of patients aged 60-80 years with a postcholecystectomy interval of 10 years or greater exhibited a significantly (p<0-05) greater frequency of adenomas (38.5%) than matched patients with a postcholecystectomy interval of less than 10 years (21.8%) and matched controls with cholelithiasis (23-7%). This increase in the frequency of adenomas was primarily accounted for by an increase in the percentage of tubular adenomas (p<0.05) and corresponded to an increase in the frequency of cancer (p<0.05) of the large bowel.An increased risk of colon cancer after cholecystectomy has recently been reported by some groupsl-6 but not by others.7-9 The results of animal studies on the effects of cholecystectomy on colonic carcinogenesis have also been controversial." -12 If the concept of an adenoma-cancer sequence is taken as correct,13 14 one should expect an increased occurrence of colonic adenomas as a function of time after cholecystectomy. The present study was designed to explore this hypothesis. Methods PATI ENTSAll colonoscopies (n=4035) performed in our unit between 1976 and 1982 were reviewed. Among these were 331 patients (group I, 233 women, 98 men) who had a history of cholecystectomy of more than one year before the examination (mean 107 years). This group represented 8 2% of all total colonoscopies performed. Among the patients with total colonoscopy we found 406 patients (group II, 266 women, 140 men) with cholecystolithiasis as documented by ultrasonography which was performed in about two thirds of all patients who underwent total colonoscopy.As the development of adenomas may depend on

Large Bowel Cancer Risk in Cholelithiasis and after Cholecystectomy

“…In addition, age might play a role. This is suggested by the results of a study [28] including more than 4,000 patients who underwent colonoscopy; the incidence of cancers and adenomatous polyps of the colon was significantly in creased if the patient's age was 60-80 years and if the post-CE interval was longer than 10 years. However, our study could not dem onstrate a higher frequency of large bowel cancer in cholecystectomized cases at a higher age.…”

Effects of cholecystectomy on the kinetics of primary and secondary bile acids.

“…Concern, however, has risen about the hypothesis, that cholecystectomy might in-crease formation and pool size of secondary bile acids, mainly DCA (3)(4)(5). Several studies have reported an increased incidence of colonic neoplasia 6-15 yr after cholecystectomy (6)(7)(8). Even though not confirmed by others (9,10), this observation has been linked to the cocarcinogenic role of excess DCA observed in animal experiments (1 1,12).…”

The role of previous cholecystectomy in patients with colorectal cancer

“…Some studies have found an increased risk in proximal colon cancer associated with cholecystectomy [4,12,45,68,72,79,80,82], and in many cases where the risk of right sided colonic cancer has been looked at the association is strongest in women [15,22,51,58,59,62,65,73,75]. Other studies have found an overall increased susceptibility to colorectal carcinoma at any site in both men and women [5,43,44,52,55], or mainly in the rectum [13]. Most of the studies in women have been in young women [47,48], but the risk has also been found to be high in older women [68].…”