Structural analysis of gallstones with thin-section petrographic microscopy: a study of 100 gallstones from Taiwanese patients

Evaluation of gallstone classification and their diagnosis through serum parameters as emerging tools in treatment: a narrative review

The treatment of gallstones is a matter of real concern as they may cause gallbladder cancer if not properly attended to. Evaluating the classification of gallstones can give major clues in their treatment as it will decide their aetiology, chemical composition, and pathogenesis. Also, serum parameters have emerged as an efficient tool for diagnosing gallstones. They can be probed to evaluate different biochemicals and the changes in their levels in gallstone patients which can be correlated with early prediction of the formation of gallstones. In the present review, a thorough search of the available literature was done starting from the earliest approaches for the classification of gallstones up to the recent advancements. The alteration in the level of serum parameters was also studied in gallstone patients so that it can act as a potential diagnostic tool for early detection of gallstone formation. The earliest classification of gallstones was done in 1896 by Nauyn. He classified them into pure cholesterol stones, laminated cholesterol stones, ordinary gallbladder stones, mixed bilirubin stones, and rare forms. The most recent classification of gallstones was done by Peter et al in 2020 and they classified them as pure, mixed, composite cholesterol, carbonate stones, black and brown pigment stones. The altered of levels of serum parameters was analyzed by Reuben (1985) and in recent times by Peter et al (2020). The various serum parameters studied were as RDW-CV test (red blood cell distribution width), PCT (prolactin) test, MPV (mean platelet count), LYM (lymphocyte) test, and EOS (eosinophil and eosinophil count test). Also, we discussed some practical considerations for gallstones that can be taken into account for gallstone prevention and diagnosis. Further research is required to detect gallstone type in the gallbladder by using the alteration in the levels of serum parameters.

Scanning electron microscopy in analysis of urinary stones

Urolithiasis is a frequent and in many cases serious disease. Proper analysis of kidney stone composition is crucial for appropriate treatment and prevention of disease recurrence. In this work, scanning electron microscopy (SEM) coupled with energy-dispersive spectroscopy was applied for a study of 30 samples covering the most common types of human kidney stones. The results are analyzed and evaluated in terms of applicability of the method for both routine kidney stone analysis as well as collecting of specific data. The method provides complex information about studied samples including morphology of the stones and of the present crystals or their aggregates. It also brings information on elemental composition of the phases. After application of standardization, quantitative microanalysis with detection limits of 400 ppm (Mg, P, S, Cl, K, Ca), 500 ppm (Na) and 1200 ppm (F) was obtained. Compositional mapping with EDS shows the elemental distribution within a sample. This study demonstrated that information on morphology and chemistry acquired by these methods was highly reliable for identification of phases, even when present in small amounts. It provided information on kidney stone structure, relationships between phases, major and minor element content, and variations in chemical composition related to the growth of the stones. SEM represents a powerful tool in urinary stone analysis, since a single facility can produce a wide spectrum of information. It can be suggested as a basic method used for routine urinary stone identification, whilst bringing additional detailed information that cannot be obtained by other methods.

Validation assessment of the Chinese (Taiwan) version of the Gastrointestinal Quality of Life Index for patients with symptomatic gallstone disease

BACKGROUND

Symptomatic gallstone is one of the most common diseases in Taiwan. The aim of this study was to develop a Mandarin Chinese outcomes measure for the assessment on quality of life among gallstone patients.

MATERIALS AND METHODS

The Gastrointestinal Quality of Life Index (GIQLI) is a valid, disease-specific measure for the evaluation of health status and treatment effectiveness for adults with chronic gastrointestinal condition. The GIQLI was translated into Mandarin Chinese using a parallel model. The Chinese (Taiwan) version of the GIQLI (CGIQLI) was administered to 102 patients with symptomatic gallstone disease in a prospective manner; the CGIQLI then was validated according to established criteria for reliability, validity, and longitudinal sensitivity.

RESULTS

The CGIQLI demonstrates good test-retest reliability (r = 0.92, P = 0.001) and internal consistency (Cronbach's alpha = 0.92). The CGIQLI significantly correlates with the Mandarin Chinese (Taiwan) version of the generic 36-Item Short-Form Health Survey (SF-36). The standardized response mean for the CGIQLI total score is 0.96, indicating excellent sensitivity to clinical change in the study group.

CONCLUSION

This validation study demonstrated that the performance characteristics of the CGIQLI are equivalent to the English version, the GIQLI. This study demonstrates that the CGIQLI is a valid tool to evaluate adults with chronic gastrointestinal problems among the Chinese-speaking population.

Laparoscopic common bile duct exploration with T-tube choledochotomy for the management of choledocholithiasis

Although laparoscopic cholecystectomy (LC) has become the gold standard for the management of gallstone disease, the application of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has been slower. The aim of this study is to determine the feasibility and effectiveness of LCBDE. A retrospective cohort study was conducted to compare LCBDE (n = 82) with conventional common bile duct exploration (CCBDE) (n = 75) and endoscopic sphincterotomy (EST) (n = 80) in the management of choledocholithiasis. All our LCBDEs were performed through choledochotomy with T-tube placement. The mean operative time of the LCBDE group (124 +/- 48 minutes) was not significantly longer then the CCBDE group (118 +/- 35 minutes), while the postoperative hospitalization was shorter in both the LCBDE (8 +/- 5 days) and EST (9 +/- 4 days) groups than in the CCBDE (13 +/- 6 days) group. In the LCBDE group, 14 patients (17.1%) required postoperative choledochoscopy to clear residual stones through the T-tube tract. The only mortality occurred in the CCBDE group. The morbidity rate was 3.7% (3/82) in the LCBDE group, including bile leakage in 1 case and bile peritonitis in 2 cases; 6.7% (5/75) in the CCBDE group, including atlectasis in 2 cases, sepsis in 1, and wound infection in 2. There were 2 cases of postoperative pancreatitis (2.5%; 2/80) in the EST group. The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (EST, 1.46 +/- 0.67; LCBDE, 1.23 +/- 0.42; and CCBDE, 1.09 +/- 0.28; P < 0.0001). Our results suggested that EST and LCBDE tended to require more therapeutic sessions then CCBDE, although these sessions were less invasive. The benefits of LCBDE include minimal invasiveness, concurrent treatment of gallbladder stone and CBD stones in a single session, and a shorter postoperative hospital stay. However a longer learning curve is needed. Selection of the most suitable therapeutic option for individual patients by an experienced surgeon gives the most benefits to patients.

Effects of variant UDP-glucuronosyltransferase 1A1 gene, glucose-6-phosphate dehydrogenase deficiency and thalassemia on cholelithiasis

AIM: To test the hypothesis that the variant UDP-glucuronosyltransferase 1A1 (UGT1A1) gene, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and thalassemia influence bilirubin metabolism and play a role in the development of cholelithiasis.

METHODS: A total of 372 Taiwan Chinese with cholelithiasis who had undergone cholecystectomy and 293 healthy individuals were divided into case and control groups, respectively. PCR and restriction fragment length polymorphism were used to analyze the promoter area and nucleotides 211, 686, 1 091, and 1 456 of the UGT1A1 gene for all subjects and the gene variants for thalassemia and G6PD deficiency.

RESULTS: Variation frequencies for the cholelithiasis patients were 16.1%, 25.8%, 5.4%, and 4.3% for A(TA)6 TAA/A(TA)7TAA (6/7), heterozygosity within the coding region, compound heterozygosity, and homozygosity of the UGT1A1 gene, respectively. Comparing the case and control groups, a statistically significant difference in frequency was demonstrated for the homozygous variation of the UGT1A1 gene (P = 0.012, χ² test), but not for the other variations. Further, no difference was demonstrated in a between-group comparison of the incidence of G6PD deficiency and thalassemia (2.7% vs 2.4% and 5.1% vs 5.1%, respectively). The bilirubin levels for the cholelithiasis patients with the homozygous variant-UGT1A1 gene were significantly different from the control analog (18.0 ± 6.5 and 12.7 ± 2.9 μmol/L, respectively; P<0.001, Student’s t test).

CONCLUSION: Our results show that the homozygous variation in the UGT1A1 gene is a risk factor for the development of cholelithiasis in Taiwan Chinese.