Gallbladder Wall Research Articles

Evaluation of gallbladder contractility and Doppler findings in patients with irritable bowel syndrome; a case-control study

Background Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder causing abdominal pain, altered bowel habits and bloating without structural issues. Gallbladder dysfunction may be linked to IBS due to disrupted cholecystokinin release. This study aims to assess gallbladder function and related hemodynamic parameters using Doppler ultrasound in IBS before and after meals. Method In this case-control study, we investigated gallbladder function differences between constipation-predominant IBS (C-IBS) patients and healthy volunteers. Participants underwent ultrasonography to measure gallbladder parameters before and after consuming a predefined meal. Gallbladder volume, wall thickness and resistance index (RI) of cystic and superior mesenteric arteries (SMA) were assessed. Student t-test and paired t-test were used to compare case and control groups and pre- and post-meal data, respectively. Results A total of 34 people (18 C-IBS and 16 healthy control) were included. The mean (Standard deviation) of gallbladder fasting volume was measured 24.74 (8.85) and 29.73 (9.65) cubic millimeter for case and controls, respectively. Postprandial volume was 11.34 (5.66) and 16.9 (6.16) cubic millimeter for case and controls respectively. We observed a statistically significant difference in emptying fractions (EF) between groups (p value = 0.009). IBS patients had a smaller fasting SMA RI (p value = 0.016) but the fraction of change after meal was not significant (p value = 0.10). The cystic artery RI did not reach statistical significance between the fasting and post-meal values (p value = 0.067). Conclusion IBS patients have a higher emptying fraction and lower change in SMA RI compared to healthy controls. Further studies with larger sample size, inclusion of patients with different coexisting conditions and subtypes of IBS and combining colon transit study with gallbladder ejection fraction evaluation can be used to further provide more meaning to this study.

Risk stratification model for incidentally detected gallbladder polyps: A multicentre study

PurposeWe aimed to develop a 4-level risk stratification model using a scoring system based on conventional ultrasound to improve the diagnosis of gallbladder polyp. MethodPatients with histopathologically confirmed gallbladder polyps were consecutively recruited from three medical centres. Conventional ultrasound findings and clinical characteristics were acquired prior to cholecystectomy. Risk factors for neoplastic and malignant polyps were used to build a risk stratification system via interobserver agreement and multivariate logistic regression analysis. The model was retrospectively trained using 264 pre-surgical samples and prospectively validated using 106 pre-surgical samples. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and malignant polyp rate. ResultsIn total, 370 patients (mean age, 51.68 ± 14.41 years, 156 men) were enrolled in this study. Size (≥12 mm), shape (oblate or round), single, vascularity, gallbladder stone or sludge were considered risk factors for neoplastic polyps. Size (≥14 mm), shape (oblate), single, disrupted gallbladder wall, and gallbladder stone or sludge were risk factors for malignant polyps (all p < 0.05). In the scoring system, the sensitivity, specificity, and AUC of score ≥ 9 in diagnosing neoplastic polyps were 0.766, 0.788, and 0.876 respectively; and the sensitivity, specificity, and AUC of score ≥ 15 in diagnosing malignant polyps were 0.844, 0.926, and 0.949 respectively. In our model, the malignancy rates at the four levels were 0 % (0/24), 1.28 % (2/156), 9.26 % (5/54), and 70.37 % (38/54), respectively. ConclusionsThe 4-level risk stratification model based on conventional ultrasound imaging showed excellent performance in classifying gallbladder polyps.

ASO Author Reflections: Surgical Middle Ground-Navigating the Intraoperatively Detected IncidentalSuspicious Gallbladder Wall Thickening: "The Parray's Approach".

ASO Author Reflections: Surgical Middle Ground-Navigating the Intraoperatively Detected IncidentalSuspicious Gallbladder Wall Thickening: "The Parray's Approach".

Pathologic examination of ectopic pancreatic tissue in the gallbladder: A case report

Abstract Introduction/Objective Ectopic pancreatic tissue (EPT) is an entity defined by the presence of pancreatic tissue at its non-physiological site, while co-existing with original tissue in its correct anatomical location. While EPT is a rare process in locations such as the stomach, duodenum, and esophagus; it is even more uncommon for it to occur in the gallbladder. To our knowledge, fewer than thirty cases of EPT in the gallbladder have been reported. The following case report presents a 47-year-old woman with ectopic pancreatic tissue in the gallbladder. Methods/Case Report A 47-year-old female presented to our emergency department with her third episode of colicky right upper quadrant pain. Ultrasound imaging demonstrated cholelithiasis with additional ill-defined findings of the gallbladder wall, which included but were not limited to acute emphysematous cholecystitis and chronic cholecystitis with features of porcelain gallbladder. Laparoscopic cholecystectomy was performed without complications. Pathologic evaluation of the specimen demonstrated a cystic structure at the fundus of the gallbladder with coexisting EPT, fundic-type adenomyomatosis, and cholelithiasis. Results (if a Case Study enter NA) NA Conclusion Ectopic pancreatic tissue is a rare incidental finding which is often confused for a malignant process. While it is more commonly seen in the gastrointestinal tract from the esophagus to the duodenum, it can present in other sites such as in this case. Currently, there is no specific imaging method to determine the presence of EPT. Ultrasonography is nonspecific and EPT can be confused for a number of conditions ranging from benign to malignant. Gross examination is fairly unremarkable, however microscopic examination is a straightforward diagnosis. While it is a benign process, malignant transformation can occur and pathologists should be aware of this possibility. For this reason, additional sections may be recommended to rule out occult malignancy.

Стан гепатобіліарної системи в підлітків з цукровим діабетом 1-го типу

Diabetes mellitus type 1 (DMT1) is one of the diseases in which liver lesions such as glycogenic hepatopathy and hepatic steatosis are frequently observed which makes our study appropriate. Purpose - to study the state of the hepatobiliary system in adolescents with DMT1 based on the results of a biochemical blood test, ultrasound examination of the hepatobiliary system and dynamic monitoring. Materials and methods. The study included 173 adolescents (87 girls and 86 boys aged 10 to 18 years who have DMT1 and were in the endocrinology department of the SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine»). Patients were divided according to the level of glycaemic control targets (GCT): the Group 1 - optimal (glycosylated hemoglobin (HbA1c) &lt;7.0%), the Group 2 - suboptimal (HbA1c = 7.0-9.0%), the Group 3 - high-risk GCT (HbA1c &gt;9.0%). The Control group included 20 healthy adolescents. All patients underwent a biochemical blood test and ultrasound. Results. Most of the examined adolescents had pain, dyspeptic syndromes and an increased size of the liver on ultrasonography regardless of the level of GCT. Ultrasound signs of hepatic steatosis were most often determined in patients with the Group 3. Dynamic observation indicated the absence of positive dynamics in reducing the size of the liver and normalizing the echogenicity of its parenchyma in 50% of patients, even when optimal GCT is reached. The majority of adolescents with DMT1 had hypotension of the gallbladder, and thickening of the gallbladder walls and the presence of biliary sludge were more often observed in patients with Groups 2 and 3. In the Groups 2 and 3 increased activity of alanine aminotransferase was revealed, which against the background of compensation for DMT1, decreased in only half of the patients. Lipidogram parameters were atherogenic in all patients, regardless of the level of GCT. Conclusions. The study revealed a high incidence of hepatopathy in adolescents with DMT1, which requires careful follow-up. The diagnostic algorithm requires the inclusion of non-invasive tests of the hepatobiliary system. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

EVOLUTION OF MORPHOLOGICAL CHANGES OF THE GALLBLADDER WALL AT DIFFERENT TERMS OF PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY

Gallstones are present in approximately 10-15 % of the adult population in Western countries, with 1-4 % of patients experiencing symptoms each year. Recent guidelines have confi rmed that laparoscopic cholecystectomy is the mainstay of treatment for acute calculous cholecystitis, but the optimal timing of cholecystectomy is still a matter of debate and research. The purpose of the study is to improve the results of surgical treatment of patients with acute obturation calculous cholecystitis by clinical and morphological substantiation of the optimal terms of laparoscopic cholecystectomy.Material and methods. To increase the safety of laparoscopic cholecystectomy, a histological study of micropreparations of the gallbladder wall after laparoscopic cholecystectomy was conducted in 30 patients, who were divided into 2 groups: 1 group – features of morphological and structural changes in the gallbladder wall up to 7 days after the onset of an attack of biliary colic (18 patients; 60 %) and group 2 – peculiarities of the morpho- structural changes of the gallbladder after 7 days from the onset of an acute attack of biliary colic (12 patients, 40 %);The results. On the basis of microscopic examination of histological preparations, it can be stated that in the early stages of the fi rst attack of cholecystitis, acute infl ammation of various morphological types (non-destructive and destructive) occurs in the wall of the gallbladder. In the late period (after 7 days), sclerotic changes develop both in the organ wall and perivesical. The main role in the pathogenesis of the remodeling of the structural components of the gallbladder is played by deep hemodynamic disorders and the prolongation of the infl ammatory process. Circulatory hypoxia, increasing under such conditions, activates the sclerosing process.

Primary Gallbladder B-Cell Lymphoma as a Finding in Post Cholecystectomy with Diffuse Gallbladder Wall Thickening: A Case Report

Primary Gallbladder B-Cell Lymphoma as a Finding in Post Cholecystectomy with Diffuse Gallbladder Wall Thickening: A Case Report

Acute Emphysematous Cholecystitis Rarely Accompanied by Necrotized Cystic Duct: A Case Report

Emphysematous cholecystitis is an acute abdominal disease characterized by gas in the gallbladder lumen and wall. Emphysematous cholecystitis and related cystic duct necrosis are rare, but if not noticed, they can cause a mortal picture up to perforation and sepsis. In this article, we present a case of emphysematous cholecystitis involving gangrenous gallbladder and necrotizing cystic duct, which developed suddenly in an immunosuppressive patient who presented to the emergency department with abdominal pain and was treated with rapid emergency successful surgery.

Flea-Borne Typhus Presenting with Acalculous Cholecystitis and Severe Anemia

Background. Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion. Albeit uncommon, the presentation of this patient’s symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high.

Predictors for Gangrene and Perforation of Gallbladder Wall in Patients with Acute Cholecystitis

Summary Perforation of the gallbladder wall leads to a local perivesical abscess or progression to biliary peritonitis. The study aimed to analyse clinical, laboratory, and imaging indicators that have the strongest relationship with the presence of gangrenous cholecystitis and perforation of the wall and to design a predictive scoring system that highlights the risk of developing gangrenous cholecystitis with perforation. We performed a retrospective analysis of a total of 331 patients operated for five years (2016-2020) at the Department of Surgical Diseases” of Medical University - Pleven, with histologically verified chronic cholecystitis (120 patients; 36.4%), acute cholecystitis (100 patients; 30.1%), and destructive cholecystitis (111 patients; 33.5%). The statistical analysis identified nine main factors with the most substantial statistical significance in patients with gangrene and perforation of the gallbladder wall: age &gt;65, male gender, diabetes mellitus, cardiovascular pathology, tachycardia&gt;90 bpm, WBC&gt;14.109, the thickness of gallbladder wall &gt; 4 mm with pericholecystic fluid, ASAT and ALAT &gt; 40 UI, CRP&gt;150 ng/l. The total possible score was 11 points. The positive predictive value of the scale was 96% and identified the cases with micro-perforation and perivesical abbesses among the group with the highest total score.

Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies".

In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. This study aims to describe current indications and timing for LC in pediatric patients. Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020-2023. In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.

Papillary neoplasms of biliary tract-a histopathological surprise

Papillary neoplasms of the biliary tract is a relatively new entity which most often comes as a histological surprise. They are often diagnosed as malignancies and are treated like that. But the prognosis is better when compared to malignancy itself. Here we reported two cases of papillary neoplasms of the biliary tract. First case was a 50 year old male who was evaluated for obstructive jaundice and on evaluation found to be type 3b hilar cholangiocarcinoma and underwent left hepatectomy with extra hepatic bile duct resection and portal lymphadenectomy. Histo-pathological report was intra-ductal papillary neoplasm - biliary type (IPN B). Second case was an incidental finding of arterial enhancing lesion in the gallbladder wall on CT scan, which was done for the evaluation of bicytopenia. This also was reported as malignancybin pre-operative imaging and hence underwent anticipated extended cholecystectomy with wedge resection of 2 cm adjacent hepatic parenchyma. Again histopathology revealed it as intra-cholecystic papillary neoplasm with focal dysplasia. Both cases were followed up for more than one and half years and showed no evidence of recurrence, hence pointing towards better prognosis. Papillary neoplasms are difficult to diagnose preoperatively and are often treated with oncological resections but they carry a better prognosis when compared with their malignancy counterparts.

Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis.

The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.

Canine Gallbladder Erosion/Ulcer and Hemocholecyst: Clinicopathological Characteristics of 14 Cases.

(1) Background: Gallbladder mucosal erosion and/or ulceration are illnesses associated with unexpected gallbladder intra-cystic bleeding (hemocholecyst), an under-reported problem in dogs. (2) Methods: Clinicopathological characteristics of 14 dogs with gallbladder erosion/ulcer were investigated in this single-center retrospective study using clinical data and archived gallbladder tissues of client-owned dogs. (3) Results: Canine gallbladder erosion/ulcer tends to occur in older, neutered dogs of various breeds. Vomiting, lethargy, and anorexia are common. Concurrent gallbladder rupture occurred in 5/14 cases (35.7%), while rupture was absent in 6/14 cases (42.8%) and undetermined in 3/14 (21.4%) cases. Histologically, the gallbladder wall was markedly thickened due to mucosal hyperplasia, inflammatory infiltrates, fibrosis, edema, hemorrhage, and smooth muscle hyperplasia/hypertrophy. Twelve out of fourteen cases (85.7%) had concurrent cholecystitis of varying severity. Bacteria were detected by Giemsa or Warthin-Starry stain in 8/14 (57.1%) cases. Bacterial rods immunoreactive to the anti-Helicobacter antibody were present in one case. Mucosal epithelial cells of the gallbladder erosion/ulcer cohort were immunopositive for the cyclooxygenases COX-1 or COX-2 in only 5/14 (35.7%) cases. In contrast, COX-1 and COX-2 were more frequently expressed in a reference pool of cases of gallbladder mucocele (n = 5) and chronic cholecystitis (n = 5). COX-1 was expressed in 9/10 cases (90.0%) of gallbladder mucocele and chronic cholecystitis and in 10/10 cases (100%) for COX-2. (4) Conclusions: Canine gallbladder erosion/ulcer is an under-reported condition which requires active clinical intervention. Based on the clinicopathological information reported in this study in addition to the COX-1 and COX-2 IHC results, we suggest that canine gallbladder erosion/ulcer may be related to decreased cytoprotection physiologically provided by arachidonic acid, but which is decreased or absent due to reduced COX expression because of yet undetermined etiologies.

Ultrasonographic aspects of the gallbladder mucocele in 30 dogs: retrospective study

Gallbladder mucocele is characterized by hyperplasia of the gallbladder epithelium, increased mucus production, accumulation, and densification of the bile content, which can lead to biliary obstruction, necrosis, and rupture of the gallbladder wall. Its finding may be accidental or related to symptoms. A retrospective study (2016-2019) was carried out based on abdominal ultrasound examinations in dogs, correlating aspects of the gallbladder and biliary system in the mucocele with existing comorbidities. Thirty dogs diagnosed with biliary mucocele were evaluated, of which 46.66% had the disease at an early stage, and 53.33% showed a more advanced stage. Of these, 66.66% were related to endocrinopathies and hyperadrenocorticism. Signs of extrahepatic bile duct obstruction and biliary peritonitis were observed in two animals. Due to their potential risk of complications, follow-up ultrasound assessments are indicated in cases that opt for clinical treatment, not excluding the need for surgical intervention.

Missed gall bladder malignancy: A result of ignoring predisposing factors

The underestimation of the prevalence of gallbladder carcinoma, which constitutes a predominant form of malignant neoplasm affecting the biliary tract, poses a significant threat due to its asymptomatic progression. Therefore, this study aimed to analyse the clinical, imaging, and intraoperative outcomes in cases of gallbladder carcinoma. This retrospective investigation was conducted from September 2022 to March 2023 at the Department of General Surgery of FH Medical College. A total of 153 patients deemed suitable for surgery participated in this study and underwent the relevant procedures. Various diagnostic and laboratory tests were administered to the patients, including blood analysis, random blood sugar determination, viral markers, chest X-ray, renal and hepatic functional tests, and comprehensive abdominal ultrasound. Gallbladder specimens were subjected to histopathological examination, and the results were documented and analysed. In histopathological reports, signs of precancerous lesions were noted in 30 out of 153 patients who underwent surgical treatment. The frequency of the disease was higher among women. Among these 30 patients, 22 had ultrasound-diagnosed gallstone disease with acute or chronic cholecystitis, while 8 patients had gallstone disease without gallbladder wall thickening. Additionally, 9 of these patients exhibited focal/irregular/thickening of the wall ≥10 mm. Overall, 16 patients showed elevated liver function, and 4 had an increased glucose level among those with histopathological evidence of precancerous lesions. This study underscores the elusive nature of gallbladder cancer, emphasizing the necessity for a comprehensive assessment, meticulous preoperative evaluation, and a multidisciplinary approach to facilitate early detection and treatment

Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain: A Case Report from the Emergency Department

BackgroundRight upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. Case ReportThis case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. Why Should an Emergency Physician Be Aware of This?Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously.

A Retrospective Analysis of Incidental Gallbladder Cancer on Post-cholecystectomy Pathological Review.

Background Gallbladder cancer is a rare cancer with a poor prognosis despite all the advances in treatment options and is mostly detected incidentally. In the current literature, re-excision is performed on patients with stage T1b and above, but high mortality rates are still observed. In this study, we aimed to investigate the reasons affecting the prognosis of incidental gallbladder cancer. Methodology Data from 33 patients were retrospectively analyzed. Patient age, sex, preoperative radiologic findings, surgical procedures, margin status, postoperative results with histologic diagnosis, T stage, complications, and mortality were evaluated. Results Of the 33 patients included in the study, 24 (72.7%) were female, nine (27.3%) were male, and the mean age was 66.4 ± 13.4 years. Seventeen (51.5%) patients in our study were aged over 65 years. Age over 65 years was found to have a significant effect on mortality (p = 0.018). In the preoperative ultrasound imaging, 27 (81.8%) patients had gallstones, two (6.1%) patients had gallbladder polyps, 31 (93.9%) had focal or diffuse thickness increases in the gallbladder wall, and nine (27.3%) patients had pericholecystic fluid. The presence of pericholecystic fluid (p = 0.039) and wall thickness (p = 0.006) were found to be associated with mortality. There was perineural invasion and lymphovascular in 17 patients each. Both perineural invasion (p = 0.016) and lymphovascular invasion (p = 0.007) were associated with mortality. Tumor grade was also associated with mortality (p = 0.001). When the prognosis of the patients was evaluated according to the T stage, the increase in the T stage negatively affected the prognosis (p < 0.001). Overall survival was a median of 17 months (95% confidence interval = 10.6-23.3). Conclusions Incidental gallbladder cancer is detected on routine histologic examination of gallbladder specimens after cholecystectomy. Most patients may require re-excision, but the prognosis is still poor in patients who have undergone re-excision. Age >65 years, pericholecystic fluid, T stage, grade, lymphovascular invasion, and perineural invasion had a significant effect on mortality, the presence of which should trigger the option of re-excision to be examined more carefully.

DETERMINANTS THAT PREDISPOSE TO CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN A TERTIARY HEALTH-CARE CENTER IN INDIA

Objectives: The aim of this study was to analyze the patient and disease-related factors of gallstone disease and also to identify pre-operative clinical, laboratory, and ultrasonic predictors that predispose to conversion of laparoscopic to open cholecystectomy. Methods: The study was prospectively conducted over 1-year duration in a tertiary care center in India. Demographic, hematological, and radiological data were recorded for all participants and compared to assess predictors of conversion from laparoscopic to open cholecystectomy. Results: A total of 526 patients participated in the study. Thirty-two cases were converted to open with 6.08% conversion rate. The common intraoperative causes of conversion were frozen Calot’s triangle, dense adhesions, and empyema gallbladder. The significant predictors of conversion were found to be a previous episode of acute cholecystitis (p=0.003), previous upper abdominal surgery (p=0.001), total leukocyte count (p=0.012) with neutrophils (p=0.005), gallbladder wall thickness &gt;5 mm (p=0.0082), and presence of pericholecystic fluid (p=0.0184). Conclusion: The above-mentioned determinants can be used to predict the chances of conversion in a patient planned for laparoscopic cholecystectomy so that the patient can be counseled regarding the risk of conversion and informed consent can be obtained, and the surgical team can be adequately prepared.

THU140 Triglyceride Glucose-body Mass Index Is A Reliable Surrogate Marker To Predict Non-alcoholic Fatty Liver Disease In Children And Adolescents

Abstract Disclosure: J. Yoon: None. K. Yi: None. Background: The triglyceride glucose (TyG) index is significantly associated with the presence of nonalcoholic fatty liver disease (NAFLD) and is a reliable insulin resistance (IR) surrogate marker. TyG index combined with body mass index (BMI) were reported to be superior to TyG index alone in predicting NAFLD in youths. Ultrasound fatty liver indicator (US-FLI) is proposed as a non-invasive, semi-quantitative method for predicting hepatitis in children with NAFLD. Objects: In this study, TyG-BMI detection ability was evaluated in children and adolescents with NAFLD diagnosed by US-FLI and compared with TyG index. We also analyzed the association between TyG-BMI and severity of NAFLD according to the US-FLI scores. Methods: Alanine aminotransferase (ALT) was used as the screening method for NAFLD (&amp;gt;26IU/L in boys and &amp;gt;22IU/L in girls), and US-FLI was performed on children who met these criteria. The US-FLI is a scoring system ranging 2-8 that evaluates based on intensity of liver/kidney contrast, posterior attenuation of ultrasound beam, vessel blurring, difficult visualization of gallbladder wall, difficult visualization of the diaphragm and areas of focal sparing. NAFLD is diagnosed by the minimum score ≥2. Healthy children of normal weight (body mass index 5-85th percentile) without metabolic comorbidities and no steatosis on ultrasound participated as a control group. TyG index was calculated as ln(fasting triglyceride (TG) [mg/dL] × fasting glucose [mg/dL]/2), and TyG-BMI were calculated as TyG × BMI. The diagnostic value of TyG-BMI for NAFLD detection was evaluated based on area under the receiver operating characteristic curve (AUC). Results: A total of 130 NAFLD patients (90 boys and 40 girls) included in this study, with mean age of 11.5±2.29 years. The control group consisted of a total of 28 subjects (17 boys and 11 girls) with mean age of 8.39±1.60 years. The TyG-BMI was significantly correlated with AST (r=0.282, p=0.005), ALT (r=0.395, p&amp;lt;0.001), HOMA-IR (r=0.444, p&amp;lt;0.001), and US-FLI (r=0.557, p&amp;lt;0.001) after controlling for sex and age. Multiple linear regression analysis showed that TyG-BMI were significantly associated with ALT (β=0.156, p=0.024), HOMA-IR (β =0.247, p&amp;lt;0.001), US-FLI (β=0.366, p&amp;lt;0.001) after adjusting for confounders. TyG-BMI was independent risk factor for NAFLD (odds ratio: 1.13, 95% confidence interval: 1.041-1.228) after controlling sex and age. In the receiver operating characteristic analysis, the TyG–BMI index (AUC=0.994, p&amp;lt;0.001) showed a better performance for detection of NAFLD than the TyG index (AUC=0.834, p&amp;lt;0.001). Conclusions: TyG-BMI is associated with insulin resistance and severity of US-FLI in NAFLD. In addition, TyG-BMI was superior to TyG index alone in detecting NAFLD. TyG-BMI is expected to be useful in detecting NAFLD and predicting disease progression in children and adolescents. Presentation: Thursday, June 15, 2023