Gallbladder Polyps Research Articles

Changes of bile acids and resting energy expenditure after laparoscopic cholecystectomy in type 2 diabetes patients: a prospective study

BackgroundWe aimed to investigate changes of bile acids and resting energy expenditure (REE) in patients with type 2 diabetes mellitus (T2DM) after laparoscopic cholecystectomy (LC) and the role in metabolic homeostasis.MethodsFrom December 2019 to December 2021, a total of 77 T2DM patients with gallbladder polyps were included in our study. Among them, 40 patients who underwent LC were enrolled into the cholecystectomy group, and 37 patients who did not undergo LC were enrolled into the control group. Preoperative and 6-months postoperative demographic data, body weight, food intake, effects on diabetes control, and biomedical variables were recorded and compared.ResultsThe mean level of total bile acids (TBA) was higher than that in the control group (P = 0.033) and increased significantly after LC compared to baseline (P = 0.029). The REE level in the cholecystectomy group was higher than that in the control group (P = 0.032) and increased compared to the baseline (P = 0.011). The utilization of carbohydrates increased significantly after LC (P < 0.001) while the utilization of fat decreased (P < 0.001). The mean level of fasting plasma glucose (P = 0.004), hemoglobin A1C (P < 0.001), and homeostasis model assessment-insulin resistance (P = 0.045) decreased after LC. The mean level of total cholesterol (P = 0.003) and low-density lipoprotein cholesterol significantly decreased (P = 0.021), whereas the level of high-density lipoprotein cholesterol increased (P < 0.001).ConclusionsThe level of REE and TBA increased after LC in patients with T2DM, and the glucose and lipid metabolism improved.Trial registration This study was registered in the Chinese Clinical Trial Registry on November 30, 2018, registered number: ChiCTR1900027823.

Risk factors for gallbladder polyps observed through second-look abdominal sonography in patients with fatty liver disease.

Multiple studies have provided varied results on the relationship between gallbladder polyps (GBPs), fatty liver disease (FLD), and metabolic factors.The purpose of this study was to determine the possible risk factors related to GBP formation in Taiwanese population through the use of health examinations.In this retrospective study, 1311 subjects who underwent abdominal sonography for health evaluations from September 2019 to August 2020 were randomly enrolled. Baseline characteristics of the study subjects were recorded. Risk factors related to GBP formation were analyzed. All participants’ series of abdominal sonography examinations in our hospital were also retrospectively reviewed to reveal the presence of GBPs through second-look sonography.Among 1311 participants, 946 participants (72.2%) had clinically evident FLD, as documented using abdominal sonography; GBPs were found in 233 (24.6%) subjects with FLD. The incidence of FLD was significantly associated with the presence of GBP (P < .001; OR: 4.16, 95% CI: 10.67–35.55). However, the severity of FLD was not found to be associated with GBP (P = .052). In a multi-variate analysis for risk factors for GBP formation, FLD (P < .0001, OR = 4.262, 95% CI: 2.17–8.34), younger group (P = .002; OR: 0.973, CI: 0.95–0.99), and alcohol consumption (P = .009; OR: 3.368, CI: 1.34–8.42) showed statistical significance. Among 1049 subjects in the nonGBP group, 56 (5.34%) persons were found to have had a GBP at least once in the other series of abdominal sonographies (P < .0001).Conclusion:FLD, older age group, and alcohol consumption are major risk factors of GBP formation in Taiwanese population. The presence of GBPs might be revealed in second-look examinations of abdominal sonographies.

Value of prediction model in distinguishing gallbladder adenoma from cholesterol polyp.

Gallbladder adenomatous polyp is a pre-cancerous neoplasm, and it is difficult to classify from cholesterol polyps before cholecystectomy. The study aimed to clarify the risk characteristics of gallbladder adenomas and establish a prediction model to differentiate gallbladder adenomas from cholesterol polyp lesions. From May 2019 to December 2021, the patients underwent cholecystectomy in the Shanghai Eastern Hepatobiliary Surgery Hospital were retrospectively reviewed. According to the permanent pathology test, the patients were divided into adenomas and cholesterol polyps groups. All the included cases received ultrasound equipment examinations before cholecystectomy and their clinical information were completely recorded. Then the patients' baseline characteristics and ultrasound imaging variables were analyzed by logistic regression. Finally, a predictive model for gallbladder adenomas will be established and assessed based on the independent risk factors. A total of 423 cases including 296 cholesterol polyps and 127 gallbladder adenomas were analyzed in detail. Multivariate logistic regression analysis revealed that solitary polyp lesion (OR=2.954, 95% CI 1.759-4.960, P<0.001), the maximal diameter of lesions (OR=1.244, 95% CI 1.169-1.324, P<0.001), and irregular shape of polyp lesions (OR=5.549, 95% CI 1.979-15.560, P=0.001) were the independent predictive factors of gallbladder adenomas. According to the results, regression equation of logit(P)=-3.828+1.083*number of gallbladder polyps lesions (GPLs)+0.218*diameter of GPLs+1.714*shape of GPLs was established. Area under the curve (AUC) was 0.828 (95% CI 0.782-0.874, P<0.001). When logit P>0.204, the sensitivity of estimating adenoma was 79.5%, the specificity of recognizing adenoma was 70.6%, and the whole correct ratio was 73.3%. While the AUC of diameter (10mm) being a predictive factor in this study was only 0.790 (95% CI 0.741-0.839, P<0.001). And the sensitivity and specificity of 10mm as the optimal diagnostic cutoff value to diagnose adenomas were 74.8% and 65.9%, respectively. The risk factors of solitary polyp lesion, larger diameter, and irregular morphology feature of polyp lesions were significantly related to gallbladder adenomas. And the predictive model established in the study can effectively identify adenomas from cholesterol polyps and help patients to select the optimal treatment protocol.

Risk of developing gallbladder cancer in patients with gallbladder polyps detected on transabdominal ultrasound: a systematic review and meta-analysis.

To estimate the risk of malignancy in gallbladder polyps of incremental sizes detected during transabdominal ultrasound (TAUS). We searched databases including MEDLINE, Embase, and Cochrane Library for eligible studies recording the polyp size from which gallbladder malignancy developed, confirmed following cholecystectomy, or by subsequent follow-up. Primary outcome was the risk of gallbladder cancer in patients with polyps. Secondary outcome was the effect of polyp size as a prognostic factor for cancer. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Bayesian meta-analysis estimated the median cancer risk according to polyp size. This study is registered with PROSPERO (CRD42020223629). 82 studies published since 1990 reported primary data for 67,837 patients. 67,774 gallbladder polyps and 889 cancers were reported. The cumulative median cancer risk of a polyp measuring 10 mm or less was 0.60% (99% credible range 0.30-1.16%). Substantial heterogeneity existed between studies (I2 = 99.95%, 95% credible interval 99.86-99.98%). Risk of bias was generally high and overall confidence in evidence was low. 13 studies (15.6%) were graded with very low certainty, 56 studies (68.3%) with low certainty, and 13 studies (15.6%) with moderate certainty. In studies considered moderate quality, TAUS monitoring detected 4.6 cancers per 10,000 patients with polyps less than 10 mm. Malignant risk in gallbladder polyps is low, particularly in polyps less than 10 mm, however the data are heterogenous and generally low quality. International guidelines, which have not previously modelled size data, should be informed by these findings. This large systematic review and meta-analysis has shown that the mean cumulative risk of small gallbladder polyps is low, but heterogeneity and missing data in larger polyp sizes (>10 mm) means the risk is uncertain and may be higher than estimated.Studies considered to have better methodological quality suggest that previous estimates of risk are likely to be inflated.

Gall bladder polyp in a bodybuilder with symptomatic uremia: An educational ultrasound image

Gall bladder polyp in a bodybuilder with symptomatic uremia: An educational ultrasound image

Relationship between gallstones and interstitial cells of Cajal in the gallbladder.

A high percentage of patients with gallstones exhibit abnormalities in gallbladder emptying, and gallstones are often associated with gallbladder contraction. Interstitial cells of Cajal (ICC) in the gallbladder are involved in the generation and spreading of spontaneous contractions of the gallbladder. This study examined the relationship among the number of gallbladder ICC, gallbladder contractility, and gallstones. Forty-six patients, who underwent cholecystectomy within 3 months of enduring a gallbladder ejection fraction scan, were enrolled in this study. ICC were identified using a microscope after immunohistochemical staining for CD117/c-kit. Five high-power field (magnification 400×) units were randomly assigned, and the number of ICC in the mucosal and muscular layers was counted. These counts were compared according to the sex, age, reason for cholecystectomy, presence of gallstone, presence of gallbladder polyp, gallbladder ejection fraction, and gallbladder size for each patient. The number of ICC in the mucosal layer was increased in the male participants (154.4 ± 73.9) compared with the female participants (107.3 ± 75.2); however, the ICC in the muscular layer was not different between the 2 groups. Additionally, the ICC in the mucosal and muscular layers did not differ according to age, cause of cholecystectomy, number of stones, stone character, stone diameter, or the presence of polyps. A larger gallbladder size was correlated with a decreased number of ICC in the muscular layer of the gallbladder. Additionally, when the number of gallbladder stones was increased, the number of ICC in the muscular layer of the gallbladder was decreased; however, there was no significant correlation between the number of ICC in the mucosal layer of the gallbladder and any of the following factors: age, GBEF, gallbladder size, stone number, or diameter. Furthermore, there was no significant correlation between the number of ICC in the muscular layer of the gallbladder, regardless of age, GBEF, and stone diameter. Although we were unable to achieve significant results regarding the relationship between GBEF and ICC, this is the first human study to reveal the relationship among ICC, gallbladder size, and the number of gallstones.

Feasibility for SERS-based discrimination of gallbladder cancer from polyp by indirect recognition of components in bile

The aqueous solution extracted from raw bile juice is composed primarily of bile salts, with lower levels of bilirubin and its derivatives. Among them, the bilirubin and bilirubin-derived metabolites are the only surface-enhanced Raman scattering (SERS)-active components. An analytical scheme indirectly responsive and able to utilize all bile components, including SERS-inactive bile salts, was explored for SERS-based discrimination of gallbladder (GB) polyp and GB cancer. Initially, the surface of a SERS substrate (Au nanodendrite on Ni foil (AuND@NiF)) was covered with an alkanethiol molecule to generate a SERS signal and attract bile components by mutual interaction. For more effective recognition of bile components, 4 independent substrates covered with 4 different alkanethiols with various functional groups (SH(CH2)2CH3, SH(CH2)2NH2, SH(CH2)2COOH, and SH(CH2)2OH) were prepared. The SERS peaks of each substrate clearly varied on interaction with pure bile components as well as aqueous bile samples, and the SERS peaks in each substrate were individually characteristic. When the principal component (PC) scores of spectra obtained using the SH(CH2)2CH3- and SH(CH2)2OH-covered substrates were combined, the k-Nearest Neighbor-based discrimination accuracy was 100%, superior to those (90.6–96.9%) using individual substrates. The use of complementary bile component-induced spectral information provided by the two substrates was responsible for accurate discrimination. On the other hand, when bare AuND@NiF recognizing only SERS-active bilirubin derivatives was used, discrimination was unsatisfactory (accuracy: 75.0%).

Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations.

Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.

Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis.

The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population. A retrospective cohort was recruited between January 2010 and December 2019at a Chilean university center. Multivariate survival analyses were conducted. Fine-Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma. Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12-128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10mm, adjusted-HR: 15.01, 95%CI: 5.4-48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01-0.55) were associated with neoplasia. In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.

Gallbladder polyps and adenomyomatosis.

Incidental findings are commonly detected during examination of the gallbladder. Differentiating benign from malignant lesions is critical because of the poor prognosis associated with gallbladder malignancy. Therefore, it is important that radiologists and sonographers are aware of common incidental gallbladder findings, which undoubtedly will continue to increase with growing medical imaging use. Ultrasound is the primary imaging modality used to examine the gallbladder and biliary tree, but contrast-enhanced ultrasound and MRI are increasingly used. This review article focuses on two common incidental findings in the gallbladder; adenomyomatosis and gallbladder polyps. The imaging features of these conditions will be reviewed and compared between radiological modalities, and the pathology, epidemiology, natural history, and management will be discussed.

THU458 - Ultrasound for the diagnosis of gallbladder polyps in PSC: polyps greater than 8 mm indicate malignancy

THU458 - Ultrasound for the diagnosis of gallbladder polyps in PSC: polyps greater than 8 mm indicate malignancy

Individualized homoeopathy in the treatment of gallbladder polyp with multiple comorbidities: A case report

Introduction: Gallbladder polyps are usually asymptomatic and detected incidentally during abdominal ultrasonography (USG). Their presence, irrespective of size, is considered an indication of surgical removal. Case Summary: A 44-year-old hypertensive and diabetic male presented with severe pain in the left lower back for 1 month. Abdominal USG revealed the presence of a 4-mm size gallbladder polyp, mild hydronephrosis of the left kidney, two left renal microliths, 5.2-mm calculus in the left vesicoureteric junction, Grade-I fatty liver and Grade-I prostatomegaly. The patient was advised for cholecystectomy, but he opted for homoeopathic treatment to avoid surgery. At the first visit, homoeopathic medicine Calcarea fluorica was prescribed and the patient was followed up periodically for 1 year. His back pain reduced within 15 days. The patient was assessed for subjective improvement through the ‘outcome related to impact on daily living’ scale. USG after 10 months of treatment revealed that the gallbladder polyp was not present and his liver, kidney and ureteric functions returned to normal as per investigations. Modified Naranjo Criteria for Homoeopathy score (+8 on the ‘−6–+13’ scale) assesses if the improvement of the patient can be attributed to the homoeopathic treatment provided. This case report is presented to document the scope of individualized homoeopathy in the treatment of gallbladder polyp with multiple comorbidities pathologies. Further, documentation of consistent results from a large number of similar cases is warranted.

Biliary Tract Disorders in Patients with Acromegaly: Single-centre Experience

Objective: Genetic and environmental factors determine the risk of biliary tract disorders. Several studies have reported an increased frequency of gallbladder disorders in patients with acromegaly belonging to different ethnic groups, however, data for Turkish patients with acromegaly is currently lacking. The primary objective of this study was to evaluate the frequency of diverse gallbladder disorders in Turkish patients with acromegaly. The secondary objective was to determine the risk factors that are related to gallstone formation. Materials and Methods: Hacettepe University electronic database was retrospectively analyzed. One hundred fifty-two out of 393 patients with acromegaly who had confirmed biliary tract disorders with imaging modalities (such as abdominal ultrasonography, abdominal computed tomography or abdominal magnetic resonance imaging) or surgery specimens, were included for final analyzes. There was not any difference between included and excluded cases in terms of study parameters. Results: Patients with acromegaly with a mean±SD age of 41±12 years were followed-up for median of 91 months. Gender distribution was equal (76 M, 76 F). Gallstones were detected in 50 (33%) cases. Seventeen (11%) cases had gallbladder sludge whereas 5 (3%) cases had gallbladder polyp. Cholecystectomy was performed in 24 (16%). Age, gender, baseline disease activity, diagnostic delay, disease duration, the presence of type 2 diabetes mellitus and hyperlipidemia were not associated with gallstone formation. Body mass index (β=1.19, 95% CI (1.09-1.30), p&lt;0.001) and somatostatin receptor ligand use (β=3.8, 95% CI (1.2-12.6), p=0.026) were determined as independent risk factors for cholelithiasis. Conclusions: Biliary tract disorders are common in Turkish patients with acromegaly. Acromegaly patients with high body mass index and on somatostatin receptor ligand treatment had an increased risk for gallstone disease.

Application of a Tele-Ultrasound Robot During COVID-19 Pandemic: A Feasibility Study.

ObjectiveTo investigate the accuracy of ultrasonic diagnosis using the tele‐ultrasound robot in Leishen Shan Hospital.MethodTwenty‐two patients with novel coronavirus pneumonia from Leishen Shan Hospital voluntarily participated in this study. Their thyroids, neck vessels, hepatobiliaries and kidneys were scanned by both tele‐ultrasound robot manufactured by Imabot Co., Ltd, Wuhan and conventional method. The ultrasound diagnosis of each patient was compared, and the ultrasound images obtained by the two methods were mixed together and double‐blindly diagnosed by an experienced ultrasound radiologist.ResultsThere were 44 positive lesions in 110 sites of 22 patients. Of which the two methods, 40 positive lesions were detected by the robotic method with 4 lesions missed (2 small polyps of gallbladder, 1 small hemangioma of liver and 1 small cyst of kidney) and 1 lesion misdiagnosed (normal carotid artery was misdiagnosed as carotid atherosclerotic plaque); 44 positive lesions were detected by conventional method with 1 small cyst of the liver was missed. There was no statistically significant difference in the accuracy rate between the robotic method and the conventional method using the chi‐square test of the four‐grid data (P>.05).ConclusionThe application of tele‐ultrasound robot meets the standard of patient care during the pandemic. The method is feasible to provide adequate ultrasound information to diagnose common abdominal, vascular, superficial organ pathologies in patients with COVID‐19 with acceptable accuracy compared with a conventional ultrasound scan.

Giant Fibrous Polyp of the Gallbladder Showing a Periphery-Dominant Contrast Enhancement: How to Differentiate It From Early Carcinoma

Although polyp size and stalk diameter are significant for the differential diagnosis of a gallbladder polyp, it is necessary to catch genuine polyp characteristics to differentiate a giant fibrous polyp from gallbladder carcinoma (GBC). This case report analyses the images and their correlation with the pathology. Transabdominal sonography revealed gallstones and a giant pedunculated gallbladder polyp measuring 32 × 18 × 14 mm with a thick stalk. The polyp lacked a hyperechoic surface line and was not delineated by either a deep hypoechoic area or a conically thickened outermost hyperechoic layer. Contrast-enhanced ultrasonography (CEUS) depicted a periphery-dominant enhancement, during the post vascular phase. A noncontrast computed tomogram (CT) did not demonstrate a gallbladder mass; meanwhile, a dynamic study revealed an enhanced polyp showing a periphery-dominant enhancement. Hence, without diagnostic findings suggestive of an obvious advanced GBC or excluding an early GBC, a full-thickness laparoscopic cholecystectomy was performed. The histopathology demonstrated a fibrous polyp with a thick stalk. In conclusion, a giant gallbladder polyp with a thick stalk showing a periphery-dominant contrast enhancement could suggest a fibrous polyp.

A New Risk Scoring System to Predict Malignancy in Gallbladder Polyps: a Single-Center Study

ObjectiveUltrasonography (US) is the most commonly used radiological method in the diagnosis of gallbladder polyps (GBPs). Patients diagnosed with GBPs on US are operated on with risk factors that do not have a high level of evidence. Our aim in this study is to determine the sensitivity of US in diagnosis GBPs, to define risk factors for neoplastic (NP) polyps, and to develop the risk scoring system. Materials and MethodsBetween July 2011 and July 2021, 173 patients who were found to have GBPs in the pathology specimens after cholecystectomy were included in the study. Patients were divided into two groups: nonneoplastic and NP groups. ResultsGBPs in patients who underwent abdominal US for any reason was 4.5%. The sensitivity of US in the diagnosis of GBPs was 56.6%. Comparison between groups, age ≥50, presence of symptoms, polyp size >12.5mm, single polyp, concomitant gallstones, and gallbladder wall thickness ≥4mm were statistically in the NP group. A risk scoring system was developed using these values. If the risk score was <4, 0.6% of GBPs was NP polyps. If the risk score was ≥4, 63.2% of GBPs were NP polyps. ConclusionOur risk scoring system can prevent unnecessary choelcystectomy. Because the incidence of NP polyps in low-risk patients (risk score <4) is extremely rare.

Feasibility of gallbladder preservation during robotic left hepatectomy: A retrospective comparative study

ObjectiveTraditionally, gallbladder is routinely removed during left hepatectomy even if there is no gallbladder pathology. However, adverse consequence after cholecystectomy, though rare, still occasionally occurs. This study aims to evaluate the feasibility of gallbladder preservation during robotic left hepatectomy. MethodsAll consecutive robotic left hepatectomy cases between December 2010 and January 2022 in Prince of Wales Hospital, the Chinese University of Hong Kong were retrieved from a prospectively collected database. The gallbladder was preserved by moving the liver transection line just away from the gallbladder fossa. Patients were divided into two groups: gallbladder preservation (GBP) and non-gallbladder preservation (NGBP). Operative results and long-term outcomes were compared between these two groups. ResultsThere were 11 cases in the GBP group and 25 cases in the NGBP group. The two groups were comparable in terms of the patient demographics and disease characteristics. There was no operative mortality. There was no difference between the two groups in operative time (GBP 270 min vs. NGBP 332 min, p = 0.132), blood loss (GBP 50 mL vs. NGBP 150 mL, p = 0.115) or complication rate (GBP 27.3% vs. NGBP 24.0%, p > 0.999). There was also no difference in 5-year overall survival. In the GBP group, no patient developed specific symptoms or complications related to the preserved gallbladder. Follow-up ultrasound or computed tomography revealed a normal appearance of the preserved gallbladders except in one patient who developed a 3-mm gallbladder polyp. On the other hand, one (4%) patient in the NGBP group developed troublesome diarrhoea after surgery. ConclusionGallbladder preservation is safe and feasible during robotic left hepatectomy. The preserved gallbladder does not lead to any symptoms, while postcholecystectomy diarrhoea can be avoided.

Gallbladder-preserving polypectomy for gallbladder polyp by embryonic-natural orifice transumbilical endoscopic surgery with a gastric endoscopy

Background and aimsCholecystectomy is performed for most gallbladder polyps (GPs). However, cholecystectomy results concerning complications in some patients. For benign GPs, adoption of gallbladder-preserving surgery is worth to recommend. We describe our experiences performing gallbladder-preserving polypectomy for GPs by embryonic-natural orifice transumbilical endoscopic surgery (E-NOTES) with a gastric endoscopy.MethodsThis is a retrospective study of patients with GPs who underwent gallbladder-preserving polypectomy by E-NOTES with a gastric endoscopy from April 2018 to September 2019 in our hospital. The operative time, intraoperative hemorrhage, intraoperative and postoperative complications, gallbladder emptying function were obtained and analyzed.ResultsThe procedure was performed successfully in all 12 patients with 5 cases of single polyp and 7 cases of multiple polyps. The range of GPs size was 2 mm to 15 mm. The mean operation time was (95.33 ± 23.08) minutes (55–135 min). There were no adverse events including heavy bleeding, mortality and conversion to open surgery during operation. All patients were discharged in 4–5 days after surgery without postoperative complications such as delayed bleeding, fever, peritonitis, intra-abdominal abscess and abdominal wall incisional hernia. All patients were followed up at 1, 3, 6, and 12 months postoperation who had almost no visible incision on the umbilical region, no recurrent GPs. The gallbladder emptying function decreased one month after surgery, and gradually improved 3, 6 and 12 months after surgery.ConclusionE-NOTES gallbladder-preserving polypectomy is a safe and effective option for patients with GPs and is close to scar-free surgery which can be performed in routine clinical practice.

The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model

Despite the high prevalence of asymptomatic gallstones (AGs), there are limited data on their natural history. We aimed to determine the rate of symptom development in a contemporary population, determine factors associated with progression to symptomatic gallstones (SGs), and develop a clinical prediction model. We used a retrospective cohort design. The time to first SG was shown using Kaplan-Meier curves. Multivariable competing risk (death) regression analysis was used to identify variables associated with SGs. A prediction model for the development of SGs after 10 years was generated and calibration curves were plotted. Participants were patients with AGs based on ultrasound or computed tomography from the general medical population. From 1996 to 2016, 22,257 patients (51% female) with AGs were identified; 14.5% developed SG with a median follow-up period of 4.6 years. The cumulative incidence was 10.1% (±0.22%) at 5 years, 21.5% (±0.39%) at 10 years, and 32.6% (±0.83%) at 15 years. In a multivariable model, the strongest predictors of developing SGs were female gender (hazard ratio [HR], 1.50; 95% CI, 1.39-1.61), younger age (HR per 5 years, 1.15; 95% CI, 1.14-1.16), multiple stones (HR, 2.42; 95% CI, 2.25-2.61), gallbladder polyps (HR, 2.55; 95% CI, 2.14-3.05), large stones (HR, 2.03; 95% CI, 1.80-2.29), and chronic hemolytic anemia (HR, 1.90; 95% CI, 1.33-2.72). The model showed good discrimination (C-statistic, 0.70) and calibration. In general medical patients with AGs, symptoms developed at approximately 2% per year. A predictive model with good calibration could be used to inform patients of their risk of SGs.

The prevalence of gallbladder polyps among residents in the urban area is significantly higher than that in the rural area on Jeju Island

The prevalence of gallbladder polyps among residents in the urban area is significantly higher than that in the rural area on Jeju Island