{"entity":{"id":"idea-gbc-typhoid-carrier-cholecystectomy-or-surveillance","kind":"idea","name":"Cholecystectomy or ultrasound surveillance for chronic typhoid carriers in endemic regions","aka":[],"tldr":"People who carry the typhoid bacterium in their gallbladder long term have about four times the usual risk of gallbladder cancer. Two meta-analyses suggest offering them gallbladder removal or regular scans; no programme has tried it.","summary":"Chronic Salmonella Typhi carriage carried a pooled odds ratio of 4.28 across 17 studies (Nagaraja and Eslick 2014) and a summary relative risk of 4.6 to 5.0 in the Chilean case-control study and meta-analysis (Koshiol 2016), with the gallbladder as the reservoir of carriage. The carrier state is diagnosable by stool culture or Vi serology and cholecystectomy is also the treatment for carriage itself. A pragmatic programme in a typhoid-endemic, gallbladder-cancer-endemic region (northern India) could randomise identified carriers to cholecystectomy or annual ultrasound and measure cancer incidence, with the added public health benefit of removing a transmission reservoir.","asOf":"2026-09-24","links":[{"label":"Nagaraja and Eslick: chronic S. Typhi carrier state and gallbladder cancer, meta-analysis (Aliment Pharmacol Ther 2014)","url":"https://europepmc.org/article/MED/24612190"},{"label":"Koshiol et al.: S. Typhi and gallbladder cancer, case-control and meta-analysis (Cancer Med 2016)","url":"https://europepmc.org/article/MED/27726295"}],"tags":["gallbladder-evidence"],"related":[],"cancers":["gallbladder"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["prophylactic-cholecystectomy","screening","inflammation"],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption","b-global-access"],"keyPapers":["paper-nagaraja-eslick-typhi-carrier-gallbladder-cancer-meta-analysis-apt-2014","paper-koshiol-salmonella-typhi-gallbladder-cancer-cancer-med-2016"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Offering cholecystectomy to confirmed chronic S. Typhi carriers aged 40 to 65 in high-incidence districts will reduce gallbladder cancer incidence in that group by at least half over ten years compared with surveillance alone.","rationale":"A fourfold relative risk on a high baseline incidence gives an absolute risk large enough to justify an operation that also cures carriage.","test":"Two-arm pragmatic randomised trial (cholecystectomy vs annual ultrasound) in identified carriers, primary endpoint gallbladder cancer incidence at ten years, secondary endpoints typhoid transmission and surgical morbidity; a preceding screening study to establish carrier prevalence and Vi serology performance.","maturity":"speculative","actor":"policy","cost":"medium","horizonYears":8},"route":"/ideas/idea-gbc-typhoid-carrier-cholecystectomy-or-surveillance/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"}],"term":[{"id":"inflammation","kind":"term","name":"Inflammation","route":"/terms/inflammation/"},{"id":"prophylactic-cholecystectomy","kind":"term","name":"Prophylactic (preventive) cholecystectomy","route":"/terms/prophylactic-cholecystectomy/"},{"id":"screening","kind":"term","name":"Screening","route":"/terms/screening/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"}],"paper":[{"id":"paper-koshiol-salmonella-typhi-gallbladder-cancer-cancer-med-2016","kind":"paper","name":"Salmonella enterica serovar Typhi and gallbladder cancer: a case-control study and meta-analysis","route":"/key-papers/paper-koshiol-salmonella-typhi-gallbladder-cancer-cancer-med-2016/"},{"id":"paper-nagaraja-eslick-typhi-carrier-gallbladder-cancer-meta-analysis-apt-2014","kind":"paper","name":"Systematic review with meta-analysis: the relationship between chronic Salmonella typhi carrier status and gall-bladder cancer","route":"/key-papers/paper-nagaraja-eslick-typhi-carrier-gallbladder-cancer-meta-analysis-apt-2014/"}],"roadmap":[{"id":"gallbladder-cancer-roadmap","kind":"roadmap","name":"Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials","route":"/roadmaps/gallbladder-cancer-roadmap/"}]}}