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Ronny Allan
We can survive without a gallbladder, but clearly it is a useful, functioning organ, and we are better off to keep it if we can. There are times when things can go wrong such as gallstones, sludge and blocked ducts, and then it may need to be removed. However……even though there wasn’t really anything wrong with my gallbladder in 2010/2011, I was convinced it had to go.
For info, gallstones incidence in the general population makes it considerably more common than NETs so it follows that some NET patients will have a gallstone issue totally unrelated to their NET. Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to help digestion. For some, an incidental finding of of a NET may be due to the patient having gallstone issues, i.e. caused by the NET (e.g. some biliary problem caused by tumours) or unrelated to NET, but the investigation uncovered the NET via imaging checks.
Most people know one thing about gallbladder – getting gallbladder stones! The normal risks and causes associated with gallstone formation – read about that here.
Gallbladder – The NET Effect
A gallbladder Neuroendocrine Neoplasm would be an ultra-rare find mainly confined to case studies rather than epidemiological overviews.
You may have read previously that I receive a monthly injection of Somatuline Autogel (Lanreotide) which keeps me well. The Lanreotide patient leaflet clearly states “Lanreotide may reduce gallbladder motility and lead to gallstone formation. Therefore, patients may need to be monitored periodically. There have been post
Consequently, for those on long term somatostatin analogues, the risk of gallstones is high. Thus, why many patients destined for long term prescription of somatostatin analogues (octreotide or lanreotide) have their gallbladder removed opportunistic during a surgery for something else. Gallstones can not only be very painful, but they can potentially be life threatening. On top of what I had already endured, future surgery to treat gallstones or to remove my gallbladder could be riskier than it might normally have been, so it was conveniently removed during a second major operation on my liver (the gallbladder is located very close).
Worth noting that these risks are in addition to the normal risks and causes associated with gallstone formation – read about that here.
Gallstone side effect of somatostatin analogues and evidence why a healthy gallbladder might need to be removed?
I also searched for studies and found this issue in technical papers (including for Acromegaly, the other condition treated by somatostatin analogues (SSA)). All the papers confirmed a risk of “Biliary stone disease” as a common side effect of SSAs. One study said the frequency ranged from 10% to 63%. The study also suggested that “patients with primary GI NET or undergoing abdominal surgery should be considered for prophylactic cholecystectomy” (gallbladder removal) – but they added that “no conclusion could be drawn on the indication of prophylactic cholecystectomy in patients with primary pancreatic or thoracic NET for whom abdominal surgery is not planned”. Study can be read here.
One fairly recent set of guidelines (2017) for Small Intestine NETs talks about gallbladder removal during surgery – read more here.
Related issues for NETs after Gallbladder removal
If the patient has also had a right hemicolectomy/terminal ileum resection, another ‘bile’ risk is Bile Acids Malabsorption (BAM) (sometimes known as Bile Salts Malabsorption and some texts described resultant diarrhea as ‘Bile Acid Diarrhea”). Following a terminal ileum resection which includes a right hemicolectomy, there is a risk that excess bile acids will leak into the large intestine (colon) via the anastomosis (the new joint between small and large intestines). Previously, the now removed ileocecal valve (junction of terminal ileum and cecum) would take care of this problem. This leakage can lead to increased motility, shortening the colonic transit time, and so producing watery diarrhea (or exacerbating an existing condition) – this can often be confused with carcinoid syndrome induced diarrhea resulting in the wrong therapeutic approach. It can also be confused with pancreatic enzyme deficiency-related issues (although the therapy for this might help). The treatment for this sort of malabsorption is normally some form of bile acid sequestrants (cholestyramine (Questran, Prevalite), colestipol (Colestid, Flavored Colestid), and colesevelam (Welchol). The trick is working out what is causing the issue and for that, you need expert advice – testing is not an exact science.
Removal of the gallbladder on top of a right hemicolectomy has the potential to exacerbate the issue
Read more here or click on the picture below.
Disclaimer
I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.
Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.
Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
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