Gallbladder Polyps and Intraductal Papillary Mucinous Neoplasms in Patients With Primary Sclerosing Cholangitis

Abstract

Introduction: Patients with primary sclerosing cholangitis (PSC) are known to be at increased risk of cholangiocarcinoma and gallbladder carcinoma. Gallbladder polyp and intraductal papillary mucinous neoplasm (IPMN) are also known to have malignant potential. The prevalence of gallbladder polyp and IPMN in general population has been estimated 4.3% - 6.9% and less than 3%, respectively. However, the available data on the prevalence of gallbladder polyp or IPMN in patients with PSC is sparse. This study is aimed to investigate the prevalence of gallbladder polyp and IPMN in patients with PSC. Methods: In this cross-sectional chart review study, 356 consecutive patients with the diagnosis of primary sclerosing cholangitis based on Magnetic Resonance Cholangiopancreatogram (MRCP), Endoscopic Retrograde Cholangiopancreatogram (ERCP) or liver biopsy, who had at least one abdominal CT scan or MRI were included. Patients with gallbladder polyp and IPMN were identified based on abdominal CT scan or MRI. To calculate the prevalence of gallbladder polyp, patients who had absent gallbladder on abdominal imaging were excluded. Age, gender, ethnicity, Body Mass Index (BMI), the presence of IPMN, gallbladder polyp and Inflammatory Bowel Disease (IBD) including Ulcerative Colitis (UC) and Crohn's Disease (CD) were studied. Results: The prevalence of IPMN and gallbladder polyp in patients with PSC was 11.8% (42/356) and 12.9% (31/240), respectively. The patients with PSC and IPMN compared to those without IPMN did not harbor any statistically significant difference in gender or race distribution, mean BMI, the frequency of IBD, UC or CD (Table 1). Additionally, there was no significant difference in the gender or race distribution, mean BMI, the frequency of IBD, UC or CD in patients with gallbladder polyp and patients without gallbladder polyp (Table 2). However, there was a statistically significant age difference between patients with IPMN and gallbladder polyp compared to those without IPMN and gallbladder polyp, respectively.Table: Table. Characteristics of patients with primary sclerosing cholangitis and IPMN compared to patients with primary sclerosing cholangitis without IPMNTable: Table. Characteristics of patients with primary sclerosing cholangitis and gallbladder polyp compared to patients with primary sclerosing cholangitis without gallbladder polypConclusion: PSC might be associated with increased prevalence of IPMN and gallbladder polyp. This association seems to be independent from underlying IBD, race and gender. In patients with PSC, older age is associated with increased frequency of IPMN and gallbladder polyp.