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Salin G, Corpechot C, Ouazana S, Dong C, Becq A, Lemoinne S, Ben Belkacem K, Leehnardt R, Chaput U, Chazouillères O, Kirchgesner J, Camus M. Endoscopic features of low-phospholipid-associated cholelithiasis syndrome: a retrospective cohort study. Clin Res Hepatol Gastroenterol 2024:102324. [PMID: 38527568 DOI: 10.1016/j.clinre.2024.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVE LPAC (low phospholipid-associated cholelithiasis) syndrome is a rare genetic form of cholelithiasis. ERCP (endoscopic retrograde cholangiopancreatography) is often used to remove gallstones in the bile duct. No published data is available on the role of ERCP in LPAC syndrome. PATIENTS AND METHODS In this retrospective cohort study, we included patients diagnosed with LPAC syndrome in a single tertiary referral center between 2009 and 2021. Our aim was to assess the frequency, indications, modalities, results, and complications of ERCP, as well as predictive factors for ERCP, in LPAC syndrome. Independent factors associated with ERCP occurrence were identified using a multivariable Cox regression analysis. RESULTS ERCP was required in 31.2% of the 269 patients included for analysis. Among patients who required ERCPs, 78.6% had the procedure before diagnosis (i.e., starting UDCA). Most common indications were choledocholithiasis (53.6%) and acute cholangitis (29.5%). Post ERCP pancreatitis, perforation and bleeding rates were 7.2%, 2.6%, and 1.3%, respectively. Age and history of cholelithiasis in first-degree relatives were associated with a higher risk of ERCP (Hazard-ratio [HR]=1.30 [95%confidence-interval [CI] 1.04-1.62] and HR=1.88 [95%CI 1.15-3.07] respectively). Female gender and UDCA intake ≥ 1 year were associated with a lower risk of ERCP (HR=0.49 [95%CI 0.29-0.82] and HR=0.44 [95%CI 0.22-0.90] respectively). Median follow-up was 10.8 years. CONCLUSION One-third of patients with LPAC syndrome undergo sphincterotomy. However, most procedures are performed before diagnosis and UDCA is associated with a lower risk of endoscopic procedure. Earlier diagnosis and treatment with UDCA may further reduce the need for ERCP in patients with LPAC syndrome.
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Affiliation(s)
- G Salin
- Sorbonne University, Hepatogastroenterology - Endoscopy unit, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France.
| | - C Corpechot
- Sorbonne University, Reference center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France; French National Cohort of Patients with LPAC syndrome RaDiCo-COLPAC, RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - S Ouazana
- Sorbonne University, Hepatogastroenterology - Endoscopy unit, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France
| | - C Dong
- Sorbonne University, Reference center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France; French National Cohort of Patients with LPAC syndrome RaDiCo-COLPAC, RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - A Becq
- Paris-Est Creteil University, Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
| | - S Lemoinne
- Sorbonne University, Reference center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France; French National Cohort of Patients with LPAC syndrome RaDiCo-COLPAC, RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - K Ben Belkacem
- Sorbonne University, Reference center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France; French National Cohort of Patients with LPAC syndrome RaDiCo-COLPAC, RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - R Leehnardt
- Sorbonne University, Hepatogastroenterology - Endoscopy unit, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France
| | - U Chaput
- Sorbonne University, Hepatogastroenterology - Endoscopy unit, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France
| | - O Chazouillères
- Sorbonne University, Reference center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France; French National Cohort of Patients with LPAC syndrome RaDiCo-COLPAC, RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - J Kirchgesner
- Sorbonne University, Department of Gastroenterology, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France
| | - M Camus
- Sorbonne University, Hepatogastroenterology - Endoscopy unit, Saint-Antoine Hospital and Research Center, Assistance Publique - Hopitaux de Paris, Paris, France
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