Cholecystectomy For Gallbladder Polyps Research Articles

Predicting Neoplastic Gallbladder Polyps: The Role of Current Surgical Indications and Preoperative Images.

Cholecystectomy for gallbladder (GB) polyps is performed primarily based on preoperative images. This study examined the accuracy of surgical indications commonly used in clinical practice for detecting neoplastic polyps and investigated further clues for predicting neoplastic polyps. This retrospective study included 385 patients who underwent a cholecystectomy for GB polyps. The predictive performances of seven surgical indications were compared by fitting the receiver operating characteristic curves. Logistic regression analysis was used to identify the candidate variables associated with predicting neoplastic polyps. Neoplastic polyps were identified in 18.9% (n=62) of the 385 patients assessed. The neoplastic group contained more females than males, larger polyps, more frequent solitary lesions, and lower platelet counts than the non-neoplastic group. Current surgical indications revealed an unsatisfactory prediction for neoplastic polyps. The optimal cutoff polyp size for neoplastic polyps by ultrasound (US) was larger than by computed tomography (CT) (12 mm vs. 10 mm). The proportion of pathologic neoplastic polyps was higher when both US and CT images were used than that predicted using a single test. Logistic regression analysis revealed larger polyps, increasing age, female sex, and lower platelet count to be associated with neoplastic polyps. The current indications for cholecystectomy in GB polyps have a low predictive value for neoplastic lesions that can lead to overtreatment. Combining the polyp size from US and CT images may reduce unnecessary surgery. In addition, knowledge of the patient's age, sex, and platelet count could help make more selective surgical decisions for neoplastic polyps.

Recent Updates on Diagnosis, Treatment, and Follow-up of Gallbladder Polyps

A gallbladder (GB) polyp is an elevation of the GB mucosa that protrudes into the GB lumen. GB polyps have an estimated prevalence of 0.3-9.5% and can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps). Pseudopolyps are most commonly cholesterol polyps but also include focal adenomyomatosis and inflammatory polyps with no malignant potential. Neoplastic polyps, however, can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are usually adenocarcinoma. Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling GB polyps. On the other hand, because it is difficult to diagnose GB polyps before surgery, alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated. The current guidelines recommend cholecystectomy for GB polyps ≥ 10 mm in size as well as suboptimal sized GB polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms. The quality of the evidence behind this practice is relatively low. Therefore, this review identifies the current gaps in the available evidence and guidelines and introduces methods that can help make decisions regarding patients who require a cholecystectomy or follow-up.

Laparoscopic cholecystectomy for gallbladder polyp: looking for a clear indication and value

Laparoscopic cholecystectomy for gallbladder polyp: looking for a clear indication and value

Clinical relevance of gallbladder polyps; is cholecystectomy always necessary?

BackgroundGallbladder polyps are common incidental findings during abdominal ultrasonography. Cholecystectomy is recommended for polyps equal or greater than 10 mm on ultrasound due to their malignant potential. However, the majority of lesions appear to be pseudopolyps with no malignant potential. Our aim was to determine the correlation between ultrasonographic findings and histopathological findings after cholecystectomy for gallbladder polyps in two institutions. MethodA retrospective analysis was performed at two Dutch institutions of patients who underwent cholecystectomy. All cholecystectomies for suspected gallbladder polyps between January 2010 and August 2017 were included. Ultrasonographic and histopathological reports were analyzed. ResultsA total of 108 patients underwent cholecystectomy for gallbladder polyps. At abdominal ultrasound sixty-five patients (60.2%) were diagnosed with multiple gallbladder polyps. The mean diameter of the polyps was 11 mm. On pathological examination after cholecystectomy, only three specimens harbored true polyps. No anomalies were found in 48 (44%) patients and 51 (47%) had cholesterolosis. ConclusionThe prevalence of true gallbladder polyps was much lower in this study than reported in literature. After cholecystectomy for gallbladder polyps diagnosed by ultrasound, 97% of patients had non-neoplastic or not identifiable lesions in the gallbladder. These findings question the usefulness of current guidelines for management of suspected gallbladder polyps.

Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder.

Backgrounds/AimsWe investigated patients' clinical and radiological data to determine preoperative factors that predict cholesterol gallbladder (GB) polyps of large size, which can be helpful for decision on further diagnostic tools.MethodsIn this study, we retrospectively analyzed 126 patients who underwent laparoscopic cholecystectomy for GB polyps >10 mm diagnosed preoperatively by abdominal ultrasonography between February 2002 and February 2016 in Department of Surgery, Sanggye Paik Hospital. Patients were divided into non-cholesterol polyps group and cholesterol polyps group, based on the postoperative pathologic diagnosis. Clinical and radiological data, such as gender, age, body weight, height, body mass index (BMI), laboratory findings, size, number and shape of the polypoid lesions, and presence of the concurrent GB stone were compared between the two groups.ResultsOf the 126 cases, 73 had cholesterol polyps (57.9%) and 53 cases were non-cholesterol polyps (42.1%). The younger age (<48.5 years), size of polyp <13.25 mm and multiple polyps were independent predictive variables for cholesterol polyps, with odd ratios (OR) of 2.352 (p=0.045), 5.429 (p<0.001) and 0.472 (p<0.001), respectively.ConclusionsAge, size and polyp number were used to predict cholesterol GB polyp among polypoid lesions of the gallbladder >10 mm. For cases in which these factors are not applicable, it is strongly recommended to evaluate further diagnostic tools, such as computed tomography, endoscopic ultrasonography and tumor markers.

Risk and Cost-effectiveness of Surveillance Followed by Cholecystectomy for Gallbladder Polyps

OBJECTIVE To ascertain the best management options for patients presenting with gallbladder polyps. DESIGN Retrospective case-note analysis. SETTING Tertiary referral teaching hospital practice. PATIENTS Patients with ultrasonography-detected gallbladder polyps. INTERVENTIONS Ultrasonography surveillance or surgery. MAIN OUTCOME MEASURES Demographic data and size and number of polyps were recorded as well as size increase and histological findings. Detection rates for potentially neoplastic and frankly neoplastic polyps were recorded and compared with complication rates from cholecystectomy. Cost-effectiveness of ultrasonography surveillance was examined. RESULTS Nine hundred eighty-six patients were identified and 467 patients underwent further follow-up. Only 6.6% of polyps exhibited an increase in size over the surveillance period. Polyps that subsequently progressed in size on surveillance had a significantly greater diameter at first presentation than those polyps that remained static (7 mm vs 5 mm, respectively) (P&lt;.05). Only 3.7% of resected polyps had malignant or potentially malignant histology. Size greater than 10 mm and increase in size during surveillance predicted neoplastic potential. CONCLUSIONS A surveillance with or without selective surgery policy could potentially detect and prevent 5.4 gallbladder cancers per 1000 individuals per year with a cost saving of more than £130000 (US $201676) per year. Cancer prevention benefits would exceed the risk ratios from cholecystectomy complications. Polyps greater than 10 mm should be resected; those between 5 and 10 mm should be under ultrasonography surveillance.

Clinical and radiologic preoperative predicting factors for GB cholesterol polyp

PurposeTo use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient.MethodsOne hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis.ResultsPatients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group.ConclusionThe clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.

373 Long-Term Outcome of Gallbladder Polyps in Patients With Primary Sclerosing Cholangitis

Background and Aims: Gallbladder (GB) polyps in PSC patients have a risk of malignancy. Recently, European Association for the study of the liver (EASL) guideline recommends cholecystectomy for GB polyp at any size in patients with PSC without strong evidences of back-up studies. We aimed to evaluate the predictors and long-term outcomes of PSC patients with GB polyps for developing malignancy. Methods: We identified 86 patients with PSC and GB polyp using HICDA codes (05756-21 with 05760-31) and radiological diagnosis codes of GB polyp/mass (760.3104) at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009. Twenty-six patients were excluded due to the indefinite diagnosis of PSC or GB polyp (n=22), known cases of cholangiocarcinoma (n=2) and no follow up data (n=2). Clinical information and pathological findings of GB polyps were reviewed. GB polyp was defined by at least two serial reports of radiological diagnosis. The estimated size of small GB polyp was 0.2 cm. Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as GB polyp with median age (interquartile range; IQR) of 49.8 years (39.3, 58.6) and 67% of them were male. Median (IQR) Mayo risk score at baseline were 0.33 (-0.11, 1.36). At baseline, 35.7% of patients had GB polyps of at least 2 polyps and 70% of patients had GB polyp with size of less than 0.6 cm. Thirty-one patients (52%) were subsequent received cholecystectomy. Eight of 60 patients (13.3%) develop GB cancer (n=8) while 2 patients had GB dysplasia. No patients without cholecystectomy develop malignant GB lesion during the median (IQR) duration of follow up of 44 (17.5, 84.3) months. By univariate analysis, patients with malignant GB lesions had significantly less frequent number of GB polyp of less than 0.6 cm at first diagnosis and at the last follow up, larger size of GB polyps at first diagnosis and at the last follow up than those with benign GB lesions. By a multivariable logistic analysis, the size of GB polyps at the last follow up was associated with malignant GB lesions (OR= 8.9; 95%CI 2.6-30.3). By using the ROC curve, the GB polyp' size ≥ 1.0 cm had a sensitivity of 99%, specificity of 94%, a negative predictive value of 99% and a positive predictive value of 77%, with an area under the curve of 98% for predicting malignant GB lesion. At the end of follow up, 6 patients (10%) died and 9 patients (15%) received liver transplantation. Conclusions: Thirteen percent of GB polyps in patients with PSC develop GB cancer. The size of GB polyps of at least 1.0 cm at the last follow up was a good predictor for malignant GB lesion.

374 The Risk of Colonic Dysplasia After Liver Transplantation for Primary Sclerosing Cholangitis

Background and Aims: Gallbladder (GB) polyps in PSC patients have a risk of malignancy. Recently, European Association for the study of the liver (EASL) guideline recommends cholecystectomy for GB polyp at any size in patients with PSC without strong evidences of back-up studies. We aimed to evaluate the predictors and long-term outcomes of PSC patients with GB polyps for developing malignancy. Methods: We identified 86 patients with PSC and GB polyp using HICDA codes (05756-21 with 05760-31) and radiological diagnosis codes of GB polyp/mass (760.3104) at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009. Twenty-six patients were excluded due to the indefinite diagnosis of PSC or GB polyp (n=22), known cases of cholangiocarcinoma (n=2) and no follow up data (n=2). Clinical information and pathological findings of GB polyps were reviewed. GB polyp was defined by at least two serial reports of radiological diagnosis. The estimated size of small GB polyp was 0.2 cm. Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as GB polyp with median age (interquartile range; IQR) of 49.8 years (39.3, 58.6) and 67% of them were male. Median (IQR) Mayo risk score at baseline were 0.33 (-0.11, 1.36). At baseline, 35.7% of patients had GB polyps of at least 2 polyps and 70% of patients had GB polyp with size of less than 0.6 cm. Thirty-one patients (52%) were subsequent received cholecystectomy. Eight of 60 patients (13.3%) develop GB cancer (n=8) while 2 patients had GB dysplasia. No patients without cholecystectomy develop malignant GB lesion during the median (IQR) duration of follow up of 44 (17.5, 84.3) months. By univariate analysis, patients with malignant GB lesions had significantly less frequent number of GB polyp of less than 0.6 cm at first diagnosis and at the last follow up, larger size of GB polyps at first diagnosis and at the last follow up than those with benign GB lesions. By a multivariable logistic analysis, the size of GB polyps at the last follow up was associated with malignant GB lesions (OR= 8.9; 95%CI 2.6-30.3). By using the ROC curve, the GB polyp' size ≥ 1.0 cm had a sensitivity of 99%, specificity of 94%, a negative predictive value of 99% and a positive predictive value of 77%, with an area under the curve of 98% for predicting malignant GB lesion. At the end of follow up, 6 patients (10%) died and 9 patients (15%) received liver transplantation. Conclusions: Thirteen percent of GB polyps in patients with PSC develop GB cancer. The size of GB polyps of at least 1.0 cm at the last follow up was a good predictor for malignant GB lesion.

Cholecystectomy for gallbladder polyp.

The management of gallbladder polyps is controversial. Cholecystectomy has been recommended for gallbladder polyps larger than 10 mm because of the association with gallbladder cancer. Cholecystectomy has also been suggested for gallbladder polyps smaller than 10 mm in patients with biliary type of symptoms. The aim of this review is to compare the benefits (relief of symptoms, decreased incidence of gallbladder cancer) and harms (surgical morbidity) of cholecystectomy in patients with gallbladder polyp(s). We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until July 2008 to identify the randomised trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing cholecystectomy and no cholecystectomy were considered for the review. We planned to collect the data on the characteristics, methodological quality, mortality, number of patients in whom symptoms were improved or cured from the one identified trial. We planned to analyse the data using the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we planned to calculate the risk ratio (RR) with 95% confidence intervals based on intention-to-treat analysis. We were unable to identify any randomised clinical trials comparing cholecystectomy versus no cholecystectomy in patients with a gallbladder polyp. There are no randomised trials comparing cholecystectomy versus no cholecystectomy in patients with gallbladder polyps. Randomised clinical trials with low bias -risk are necessary to address the question of whether cholecystectomy is indicated in gallbladder polyps smaller than10 mm.

Sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by strictures of the biliary tree. It is closely associated with inflammatory bowel disease, particularly ulcerative colitis, although the precise etiology remains unknown. The prevalence of PSC, with its attendant medical burdens, appears to be higher than previously estimated; consequently, increasing numbers of patients are being diagnosed and treated in secondary care. Research into etiopathogenesis, epidemiology, small-duct PSC, and associations with cholangiocarcinoma and colorectal carcinoma are discussed, along with medical therapy and transplantation. Small-duct PSC is a distinct clinical entity associated with a benign course and minimal risk of cholangiocarcinoma compared with large-duct PSC. The incidence of gall bladder cancer is increased in patients with PSC, and yearly ultrasonographic screening, with cholecystectomy for gall bladder polyps, is recommended. Recent pilot studies have suggested that high-dose ursodeoxycholic acid (20 mg/kg body weight) may slow liver fibrosis and cholangiographic appearances. Importantly, ursodeoxycholic acid has also been shown to reduce the incidence of colonic dysplasia and colorectal cancer in patients with PSC and ulcerative colitis. Endoscopic therapy, usually balloon dilatation, is effective for benign dominant strictures that are causing jaundice. Liver transplant remains the only treatment in end-stage disease; however, posttransplant recurrence of PSC occurs in as many as one third of patients. Colorectal cancer develops posttransplant in 5 to 10% of those with inflammatory bowel disease. Annual screening colonoscopy is recommended for all patients with PSC with coexisting inflammatory bowel disease.