Association Between Cholecystectomy and Nonalcoholic Fatty
Liver Disease: A Meta-analysis
Veeravich Jaruvongvanich1,2 • Anawin Sanguankeo3,4 • Suthinee Jaruvongvanich2 •
Sikarin Upala3,4
Published online: 3 March 2016
Socie´te´ Internationale de Chirurgie 2016
To the Editor,
We read an article written by Yun el al. [1] with interest.
The authors performed a prospective study in 86 subjects
who had cholecystectomy due to gallbladder disease to
assess the alteration of liver parenchymal steatosis. They
found that hepatic steatosis significantly developed after
3 months of follow-up regardless of alcohol use. Cholecystectomy might be the risk factor for hepatic steatosis but
this conclusion needs to be confirmed in larger population
with confounder adjustment. Previous studies have shown
conflicting results as to whether cholecystectomy is associated with increased risk of fatty liver. Thus, we performed a meta-analysis to determine the association
between cholecystectomy and nonalcoholic fatty liver
disease (NAFLD).
We performed a comprehensive search of Cochrane
Central Register of Controlled Trials, MEDLINE, and
EMBASE databases until January 2016. The inclusion criterion was the observational studies’ assessment of the effect
of cholecystectomy in adults on the incidence or prevalence
of NAFLD. We included only studies with confounder
adjustment. We estimated pooled odds ratio (OR) of NAFLD
comparing between subjects with and without cholecystectomy using random-effect model. The between-study
heterogeneity was quantified using the Q statistic and I
2
.
The initial search yielded 288 articles. Twelve articles
underwent full-length review and data were extracted from
four observational studies (one case–control [2] and three
cross-sectional studies [3–5]) involving 63,028 participants
(20,405 had NAFLD). NAFLD was ascertained by ultrasonography without other identifiable causes of chronic
liver disease. Cholecystectomy was significantly associated
with the development of NAFLD with pooled OR of 1.46
(95 % CI 1.02–2.11, P = 0.04). The statistical betweenstudy heterogeneity (I
2
) was 86 %, P = 0.07.
From the result, cholecystectomy should be considered a
risk factor for the development of NAFLD. The exact
mechanism underlying the association between cholecystectomy and NAFLD remains poorly understood. Gallbladder functions as the linkage between liver and gut in
liver-gallbladder-gut axis, maintaining metabolic homeostasis of triglyceride, cholesterol, and bile acids. Gallbladder removal results in the alteration of enterohepatic
circulation of bile acids. Furthermore, gallbladder mucosa
also secretes signaling molecules that modulate metabolic
functions; thus the absence of this organ may result in
metabolic derangement.
