Gallstones are more common in patients with cirrhosis of the liver, and the incidence increases with severity of liver disease. Pigment stones are the most frequent type of gallstones (GSs) in cirrhotics, and majority remain asymptomatic. Hepatitis C virus infection and nonalcoholic fatty liver disease are the underlying etiologies of liver diseases that most often associated with GSs. Multiple altered mechanisms in cirrhosis such as chronic hemolysis due to hypersplenism, reduced bile acid synthesis and transport, decreased cholesterol secretion, decreased apolipoprotein A-I and A-II secretion, gallbladder hypo-motility, autonomic dysfunction, and portal hypertension collectively lead to increased risk of lithogenesis. Asymptomatic GSs should be followed up closely and offered laparoscopic cholecystectomy once symptomatic in Child-Pugh class A and B patients. The model for the end-stage liver disease score is the best predictor of the outcome after cholecystectomy. In patients of Child-Pugh class C, conservative or minimally invasive approaches should be used to treat complications of GSs.
Keywords: ACLF, acute-on-chronic liver failure; CBD, common bile duct; CTP, Child-Pugh; Child-Pugh class; EPBD, Endoscopic papillary balloon dilatation; EST, endoscopic sphincterotomy; EUS, endoscopic ultrasound; FXR, farnesoid X receptors; GSs, Gallstones; HBV, hepatitis B virus; HCV, Hepatitis C virus; IR, insulin resistance; LC, laparoscopic cholecystectomy; MELD, Model for end-stage liver disease; NAFLD, non-alcoholic fatty liver disease; NS 5A, non-structural protein 5A; cirrhosis; gallstone; laparoscopic cholecystectomy.
© 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.