EUS is necessary for differential diagnosis in patients with Suspicious Gallbladder Wall Lesions

Abstract

Introduction: Differential diagnosis is often difficult for suspicious gallbladder (GB) wall lesions. The purpose of this study was to evaluate the efficacy of endoscopic ultrasonography (EUS) in the differential diagnosis of suspicious GB wall lesions. Methods: Preoperative EUS evaluation with transabdominal ultrasonography and abdominal computed tomography was done in 22 patients who underwent cholecystectomy because neoplastic GB wall lesions could not be ruled out between March 2005 and February 2006 in Seoul National University Hospital. We retrospectively reviewed the medical records. Results: Age of 22 patients was mean 56.5±14.7 years. Among them, 13 were male. The pathologic evaluation revealed cholesterol polyp in 3 patients, adenomyomatosis in 1 patient, adenoma in 2 patients, adenocarcinoma in 7 patients and chronic inflammatory change in 9 patients. Preoperative diagnosis for the GB wall lesions was correct only in 6 of 22 patients (27.2%) without EUS evaluation. However, preoperative evaluation supplemented by EUS more correctly diagnosed the gallbladder wall lesions (59.1%, 13/22) (p<0.05). Furthermore, preoperative evaluation with EUS for differentiation of neoplastic lesions from others was more correct (72.7%, 5/12) than without EUS (45.4%, 10/22) (p<0.01). And, preoperative EUS evaluation correctly diagnosed the GB wall lesions in 5 (71.4%) of 7 patients with gallstones and in 8 (53.3%) of 15 patients without gallstones, however, statistical differences was not significant (p=0.65). In addition, gallstones did not influenced on differentiation neoplastic lesions from others with EUS (p=0.82). Conclusions: EUS was effective in differential diagnosis of suspicious GB wall lesions regardless of the presence of gallstones. So, EUS could be recommended when neoplastic lesions could not be ruled out in patients with suspicious GB wall lesions.