Gallbladder Polyps Research Articles

The Role of Endoscopic Ultrasonography in the Differential Diagnosis of Polypoid Lesions of the Gallbladder: an Update

Although most gallbladder (GB) polyps are benign, some early carcinomas of the GB share the same appearance as benign polyps. Currently, GB polyps larger than 1 cm should be surgically removed because of the increased risk of malignancy. Distinguishing between nonneoplastic and neoplastic lesions is are a major diagnostic dilemma, and the therapeutic options for these lesions remain controversial. Endoscopic ultrasonography (EUS) is considered to be superior to the conventional US for imaging GB lesions since EUS can provide high-resolution images of small lesions with higher ultrasound frequencies. However, differential diagnosis remains difficult, especially for small GB polyps. Thus, various diagnostic methods using EUS have been introduced to overcome the difficulty of differential diagnosis between neoplastic and non-neoplastic polyps. Contrast-enhanced harmonic EUS is useful for observing microvascular patterns and additional enhancement images of GB polyps. This requires a post-recording analysis due to a short enhancement time. Real-time color Doppler-EUS provides the Doppler flow of vessels without a time limit. Keywords: Gallbladder, polyp; Endoscopic ultrasonography 중심 단어: ë‹´ë‚­ìš©ì¢ ; 내시경 초음파

Are metabolic syndrome and its components a risk factor for gallbladder polyps?

Background. Gallbladder polyps are usually benign lesions originating from the mucosa and are usually detected incidentally during radiological examinations or after cholecystectomy. Gallbladder polyps are common and may have malignant risk. In this study, it was investigated whether metabolic syndrome (MS) is a risk factor for gallbladder polyps. This study aimed to determine the prevalence of MS and its components in patients with gallbladder polyps. Materials and methods. We conducted a retrospective, cross-sectional study. We investigated the age, gender and past medical history of 90 adults (45 with polyps, 45 without polyps). Body height and weight, body mass index, waist circumference and laboratory data were obtained from the hospital data processing system. National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Foundation (IDF) MS diagnostic criterion were used for the diagnosis of MS. Results. 51.1% (n=46) of the subjects participating in the study were female and 48.8% (n=44) were male. The mean age was 58.79±15.70 years. MS was found in 56.7% (n=51) of the cases according to the criteria of NCEP-ATP III and, in 64.4% (n=58) of the cases according to the IDF criteria. In patients with a gallbladder polyp, MS was detected in 55.55% according to the criteria of NCEP-ATP III and in 66.66% according to the IDF criteria. The rates of MS were not similar in the gallbladder polyp group and control group (p>0.01). Abdominal obesity was found to be a risk factor for the development of gallbladder polyp (odds ratio: 14.23, 95% CI: 1.751–15.722; p<0.01). Although it was not statistically significant, low HDL and hypertension were detected approximately 2 times higher in patients with gallbladder polyps than in the control group. Conclusions. While MS is not associated with the development of gallbladder polyp, obesity is seen as a sole risk factor.

Risk factors for the onset of gallbladder cancer: a review

Gallbladder cancer (GBC) is the most common malignancy of the biliary system in clinic, which has the characteristics of insidious onset and high degree of malignancy. Most patients have progressed to an advanced stage when they are diagnosed. Early identification of risk factors of the onset of gallbladder cancer and active intervention are the key to improve the rate of early diagnosis and prognosis of gallbladder cancer. At present, the risk factors related to the onset of gallbladder cancer include gallstone, gallbladder polyps, primary sclerosing cholangitis, etc. In this review, we discuss the relevant latest research on the risk factors of the onset of gallbladder cancer in order to provide clinical evidence for the prevention and early diagnosis of gallbladder cancer. The intervention, follow-up, and monitoring of risk factors should be strengthened, and the possibility of malignancy of the gallbladder should be accurately assessed in combination with factors such as age and sex. In the case of possible malignancy, prophylactic cholecystectomy should be actively performed.

Is Contrast-Enhanced Ultrasound Superior to Computed Tomography for Differential Diagnosis of Gallbladder Polyps? A Cross-Sectional Study.

ObjectiveTo compare the clinical value of contrast-enhanced ultrasonography (CEUS) versus computed tomography (CT) for distinguishing neoplastic and non-neoplastic gallbladder polyps. Given whether laparoscopic cholecystectomy is needed, differential diagnosis of neoplastic and non-neoplastic gallbladder polyps is more important than benign and malignant polyps.MethodsA total of 89 consecutive patients with polypoid lesions of the gallbladder > 10 mm in size without local invasion or distant metastasis during primary screening were enrolled in this prospective and comparative study. All patients who met the inclusion criteria underwent CEUS and CT examinations prior to surgical resection. The enhancement patterns and microvascular imaging types were analyzed on CEUS. The maximum diameter and CT value of the lesions were also recorded and subjected to a comparative analysis. The clinical value of the two diagnostic methods is compared.ResultsOf the 89 patients, there were 58 (65.2%) cases of non-neoplastic polyps and 31 (34.8%) cases of neoplastic polyps. The average diameter of neoplastic polyps was significantly higher than that of non-neoplastic polyps (P<0.001). The detection rate using CEUS was 100%. The proportion of perceived non-neoplastic polyps in the nonenhanced and arterial phases were 48.3% and 77.6%, respectively, which were significantly lower than those of neoplastic polyps (93.5%, P<0.001 and 100.0%, P<0.001, respectively). However, in the venous and delayed phases, all cholesterol polyps and neoplastic polyps were perceived. CT showed that non-neoplastic polyps exhibited delayed enhancement. On CEUS 29.0% neoplastic polyps showed a perfusion defect, whereas 6.9% non-neoplastic polyps showed a perfusion defect (P=0.005). The microvascular architecture of the lesions on CEUS was categorized into 4 types: spotty, linear, branched, and spinous, and there were significant differences between the two groups (P<0.001). The sensitivities and specificities were 87.10% and 68.97% for CEUS and 83.87% and 77.59% for CT, respectively (P=0.406).ConclusionsCEUS and CT are useful for differential diagnosis of neoplastic and nonneoplastic polypoid lesions of the gallbladder. Diagnostic efficacy was comparable between CEUS and CT. Thus, CEUS is preferred over CT in the differential diagnosis of neoplastic and non-neoplastic gallbladder polyps due to its comparable diagnostic efficacy and lack of radiation dose.

Anesthesia For Laparoscopic Cholecystectomy In A Patient With Transverse Myelitis: A Case Report

Background: Transverse Myelitis is a rare inflammatory disorder of the spinal cord presenting with sensory, motor, and autonomic dysfunction. Patients of transverse myelitis may present to operation theater for a variety of surgical procedures. The debilitating nature of the disease and interaction with anesthetic agents poses serious challenges during perioperative period. Choice of anesthesia is debatable but the complication following anesthesia can be prevented with thorough preoperative preparation and judicious use of anesthetic agent with neuromuscular monitoring. We present a successful conduction of laparoscopic cholecystectomy in a patient with transverse myelitis.&#x0D; Case Presentation: A 55-year-old female who was a known case of transverse myelitis presented for laparoscopic cholecystectomy to remove a gall bladder polyp. Except for weakness in bilateral lower limbs which had improved since her diagnosis of transverse myelitis two months back, she had no significant past medical and surgical history. Considering the grave possibility of malignant potential in polyp, cholecystectomy was urgent. Her vitals were within normal limits. Other systemic examinations revealed no abnormalities. She was planned under general anesthesia with avoidance of muscle relaxants and intraoperative use of bispectral index and train-of-four monitoring. The intra-operative period was successfully managed with propofol induction, fentanyl as analgesia, I-gel for maintenance of airway, and isoflurane for maintenance of anesthesia. Bispectral index was targeted to 40-60. Intra-operative, and post-operative period was uneventful and she had no exacerbation in her symptoms in the subsequent follow-up.&#x0D; Conclusion: As transverse myelitis is an uncommon condition and often not encountered routinely, the patient present real anesthetic challenge for an unsuspecting anesthesiologist. The successful management of such case especially with the use of novel anesthetic monitoring technique provide us with sufficient evidence that dreadful complications of transverse myelitis like exacerbation of motor, sensory and autonomic dysfunction can be avoided.

Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound in Differential Diagnosis of Gallbladder Cholesterol and Adenomatous Polyps (1-2 cm).

This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P< .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P< .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.

Simultaneous Metastasis of the Pancreas and Gallbladder from Renal Cell Carcinoma

The importance of this report is to illustrate a simultaneous metastasis of the pancreas and gallbladder from renal cell carcinoma (RCC) which is a unique situation. This is the case of a 75-year-old woman who underwent a nephrectomy a few years ago for renal cell carcinoma in whom a lesion of the tail of the pancreas and a gallbladder polyp were found simultaneously. We decided to proceed with a caudal pancreatectomy and cholecystectomy at the same time. We thought that the pancreatic lesion was a probable metastasis of renal cell carcinoma and that the vesicular polyp was independent of this pathology. Finally, pathological analysis of the surgical specimens concluded pancreatic and gallbladder metastasis of renal cell carcinoma. Incidence of pancreatic metastasis or gallbladder metastasis is rarely noted. Therefore, simultaneous renal cell carcinoma metastasis to the pancreas and gallbladder is an unique situation. Here, we present an unusual case of simultaneous metastasis of the pancreas and gallbladder from renal cell carcinoma, treated by surgery.

Primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease characterized by inflammatory destruction of the intrahepatic and/or extrahepatic bile ducts, leading to bile stasis, fibrosis, and ultimately to cirrhosis, and often requires liver transplantation (LT). PSC occurs more commonly in men, and is typically diagnosed between the ages of 30 and 40. Most cases occur in association with inflammatory bowel disease (IBD), which often precedes the development of PSC. PSC is usually diagnosed after detection of cholestasis during health evaluation or screening of patients with IBD. When symptomatic, the most common presenting symptoms are abdominal pain, pruritus, jaundice or fatigue. The etiology of PSC is poorly understood, but an increasing body of evidence supports the concept of cholangiocyte injury as a result of environmental exposure and an abnormal immune response in genetically susceptible individuals. PSC is a progressive disease, yet no effective medical therapy for halting disease progression has been identified. Management of PSC is mainly focused on treatment of symptoms and addressing complications. PSC can be complicated by bacterial cholangitis, dominant strictures (DSs), gallbladder polyps and adenocarcinoma, cholangiocarcinoma (CCA) and, in patients with IBD, colorectal malignancy. CCA is the most common malignancy in PSC with a cumulative lifetime risk of 10-20%, and accounts for a large proportion of mortality in PSC. LT is currently the only life-extending therapeutic approach for eligible patients with end-stage PSC, ultimately required in approximately 40% of patients. LT secondary to PSC has an excellent outcome compared to other LT indications, although the disease can recur and result in morbidity post-transplant.

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study

BackgroundPolypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications. MethodsA large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG. ResultsPatients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion. ConclusionsConsidering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.

Malignancy in elective cholecystectomy due to gallbladder polyps or thickened gallbladder wall: a single-centre experience

Introduction Gallbladder cancer is a rare but aggressive malignancy. Surgical resection is recommended for gallbladder polyps ≥10 mm. For gallbladder wall thickening, resection is recommended if malignancy cannot be excluded. The incidence of gallbladder malignancy after cholecystectomy with indications of polyps or wall thickening in the Swedish population is not known. Material/methods A retrospective study was performed at Linköping University Hospital and included patients who underwent cholecystectomy 2010 − 2018. All cholecystectomies performed due to gallbladder polyps or gallbladder wall thickening without other preoperative malignant signs were identified. Preoperative radiological examinations were re-analysed by a single radiologist. Medical records and histopathology reports were analysed. Results In all, 102 patients were included, of whom 65 were diagnosed with gallbladder polyps and 37 with gallbladder wall thickening. In each group, one patient (1.5% and 2.7% in each group) had gallbladder malignancy ≥ pT1b.Two (3.1%) and three (8.1%) patients with gallbladder malignancy < T1b were identified in each group. Discussion/conclusion This study indicates that the incidence of malignancy is low without other malignant signs beyond gallbladder polyps and/or gallbladder wall thickening. We propose that these patients should be discussed at a multidisciplinary tumour board. If the polyp is 10–15 mm or if the gallbladder wall is thickened but no other malignant signs are observed, cholecystectomy can be safely performed by an experienced general surgeon at a general surgery unit. If the histopathology indicates ≥ pT1b, the patient should be referred immediately to a hepatobiliary centre for liver and lymph node resection.

Contrast-enhanced ultrasound to assess gallbladder polyps

PurposeTo assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. MethodsA total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. ResultsThere were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. ConclusionVascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.

Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion.

To compare the diagnostic value of high frame rate contrast-enhanced ultrasound (H-CEUS) in distinguishing gallbladder adenomas from cholesterol polyp lesions with that of CEUS. This study enrolled 94 patients with gallbladder polyp lesions (GPLs) who underwent laparoscopic cholecystectomy. CEUS and H-CEUS were performed before surgery. The perfusion features of GPLs and the final diagnosis as determined by both technologies were compared. There were differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on H-CEUS (p < 0.05), while there were no differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on CEUS (p > 0.05). In the cholesterol polyp lesion group, there were no differences in vascular types between CEUS and H-CEUS (p > 0.05), while the vascular types were different between CEUS and H-CEUS in the gallbladder adenoma group (p < 0.05). The diagnostic value of H-CEUS in distinguishing gallbladder adenomas from cholesterol polyp lesions was better than that of CEUS. H-CEUS improved the time resolution by increasing the frame rate, which helped to accurately reflect the difference in the microcirculation of GPLs and improved the ability of a differential diagnosis between cholesterol polyp lesions and adenomas. H-CUES may provide an effective means of imaging for patients with GPLs regarding the choice of treatment options. • High frame rate CEUS improves the time resolution of CEUS by increasing the frame rate. • High frame rate CEUS is helpful to accurately evaluate the microvascular morphology of a gallbladder polyp lesion in the arterial phase. • High frame rate CEUS helps patients with gallbladder polyp lesions to choose the appropriate treatment means.

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population.

BackgroundGallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population.MethodsA retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used.ResultsOf 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031).ConclusionCholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

Gallbladder Disorders: A Comprehensive Review

Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.

Gallbladder polyps: modern approaches to diagnostics and treatment

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.

Imaging based flowchart for gallbladder polyp evaluation

BackgroundPreoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. MethodsA prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. ResultsHistopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. ConclusionsThe presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.

Laparoscopic Cholecystectomy for Gallbladder Dysfunction and Polyps: Incidence and Follow up.

Aim:This study aims to evaluate the incidence, indications, management, and long term follow up of cholecystectomy in patients with no gallstones, other than acalculous acute cholecystitis.Methods:Prospectively collected data of 5675 patients undergoing laparoscopic cholecystectomy (LC) over 28 years was extracted and analyzed. Patients with biliary symptoms, no stones on ultrasound scans and abnormal hepatobiliary iminodiacetic acid scans, and those with confirmed gallbladder polyps (GBP) were included.Results:Two percent of cholecystectomies were performed in patients with acalculous pathology [1.3% functional gallbladder disorder (FGBD) and 0.7% GBP]. The 114 patients were younger, had lower American Society of Anesthesiologists classification, and had fewer previous biliary admissions than those with gallstones (5560). The clinical presentations of FGBD were chronic biliary symptoms (93.1%) and acute biliary pain (6.9%). GBP patients presented with chronic biliary symptoms. LC in 98.6% FGBD and 92.8% GBP were significantly easier than those for gall stones (P < 0.0001). They were significantly (P < 0.0001 FGBD and P < 0.001 GBP) less likely to have adhesions to the gallbladder. This ease was reflected in shorter operation times and lower utilization of abdominal drains. Polyp numbers ranged from 1 to 30 and sizes from 1 mm to 11 mm. No malignant polyps were encountered. In 95.8% FGBD and 95% GBP, patients had a good symptomatic response to LC.Conclusions:FGBD and GBP are uncommon in patients undergoing LC. FGBD should be considered during evaluation of right upper quadrant pain with no gall stones. Laparoscopic cholecystectomy may be considered as it achieves long term symptomatic relief in most patients with FGBD and GBP.

Clinical Effect and Effective Rate of Laparoscopic Cholecystectomy for Gallstones Complicated with Gallbladder Polyps

This paperA total of 62 patients with gallstones and gallbladder polyps were selected from May 2019 to May 2020, who were divided into the observation group (n=31, laparoscopic cholecystectomy) and the control group (n=31, open cholecystectomy) in a 1:1 ratio. The clinical indicators, clinical efficacy, level of pain and complication rate of the two groups were recorded and compared. Results Indicators such as the operation duration (38.64±14.42min), blood loss (30.42±8.21ml), length of stay (4.71±1.82 d), first anal exhaust (21.82±6.65min), drainage volume (72.02±4.21ml), length of incision and the time for the recovery of gastrointestinal functions in the observation group were better than the control group (P&lt;0.05). The clinical efficacy of the observation group (96.77%) was higher than that of the control group (80.65%), with statistical value =4.0260 (P&lt;0.05). The level of pain of the observation group was lower than that of control group (P&lt;0.05), while the complication rate in the observation group (3.22%) was also lower than that of the control group (22.58%) (P&lt;0.05). Laparoscopic cholecystectomy is an effective treatment of gallstones complicated with gallbladder polyps, which can alleviate pain and improve the prognosis, and is thus worthy of promotion.

Malign Safra Kesesi Polipleri için Risk Faktörleri

PURPOSE: The aim of this study is to determine risk factors for malignancy in gallbladder polyps. METHODS: 92 patients who underwent laparoscopic cholecystectomy due to gallbladder polyp were retrospectively analyzed. Demographic data of the patients, size and number of polyp, the presence of gallstones and histopathological features of the polyps were recorded. RESULTS: 92 patients were included. Mean age was 45.78±11.21 years (21-72). 59 of the patients (64.1%) were female and 33 (35.9%) were male. Mean polyp size was 8.17±2.19 mm and 35 patients (38.0%) had a single polyp, while 57 (62.0%) had multiple polyps (≥2). 47 of the patients (51.1%) had gallstone disease, while 45 (48.9%) had no stone disease. Benign polyps (Group 1) were found in 79 patients (85.9%) and adenocarcinomas (Group 2) were found in 13 (14.1%). Of the benign polyps, 71 (77.1%) were non-neoplastic polyps and 8 (8.8%) were neoplastic polyps (adenomas). Of the 13 patients with adenocarcinomas, 11 (11.9%) were T1a and 2 (2.2%) were T1b. Mean age was 44.32±11.03 years in Group 1 and 54.61±8.07 years in Group 2, the latter being significantly older (p=0.002). Mean polyp size was 7.47±5.51 mm in Group 1 and 12.46±1.89 mm in Group 2, with a significant difference (p&lt;0.001). The cut-off value to detect malignant polyps was a polyp size of 10.5 mm with 92.3% sensitivity, 84.8% specificity, and 0.934 accuracy (p&lt; 0.001). The cut-off value to detect malignant polyps was an age of 50.5 years with 76.9% sensitivity, 67.1% specificity, and 0.767 accuracy (p=0.002). Polyp size and age were important risk factors for malignant gallbladder polyps (p&lt;0.001, OR=2.313; 95% CI: 1.502–3.561), (p=0.004, OR=1.100, 95% CI: 1.030–1.175). CONCLUCISION: We recommend cholecystectomy for asymptomatic patients aged above 50 years with gallbladder polyps larger than 10 mm due to the increased risk of malignancy.

Feasibility of discrimination of gall bladder (GB) stone and GB polyp using voltage-applied SERS measurement of bile juice samples in conjunction with two-trace two-dimensional (2T2D) correlation analysis.

Voltage-applied SERS measurement of bile juice in conjunction with two-trace two-dimensional (2T2D) correlation analysis was demonstrated as a potential tool to enhance discrimination of gall bladder (GB) stone and GB polyp. When SERS spectra of the aqueous phases extracted from raw bile juice samples were measured with applying external voltage from -300 to +300 mV (100 mV intervals), subsequent spectral variations of the adsorbed components (bilirubin-containing compounds) on the SERS substrate were minute, and discrimination of the two GB diseases in a principal component score domain was difficult. Therefore, 2T2D correlation analysis, effectively identifying asynchronous (dissimilar) spectral behaviors in the voltage-induced SERS spectra, was used to improve the discrimination. When two spectra of a sample collected with application of +100 and +300 mV were adopted, the features of subsequent 2T2D slice spectra were characteristic, and discrimination of GB stone and GB polyp substantially improved. External voltage application and recognition of the voltage-induced spectral features by 2T2D correlation analysis were key factors for the improvement. Since the demonstrated method relied on only a few SERS-active compounds, infrared (IR) spectroscopy featuring all the present components in the samples was also evaluated for comparison. However, the IR-based discrimination was inferior because the metabolite compositions in the samples between the GB diseases were not noticeably different.