Gallstone Disease In Patients Research Articles

Association of apolipoprotein E gene polymorphism with gallstone disease in Iraqi Kurdish women

Gallstone disease (GSD) is a worldwide problem; the frequency of GSD varies greatly amongst different ethnic groups, possibly due to environmental and genetic factors. One circulating lipoprotein involved in lipid metabolism is apolipoprotein E (APOE). The APOE gene is polymorphic, has three distinct alleles, APOE2, APOE3, and APOE4. The an APOE polymorphism is linked to a variety of diseases, including Alzheimer's and type-two diabetes, so this study aimed to assess the relationship among various APOE genotypes and alleles with gallstone cases in Iraqi Kurdish women. The present case-control study involved 81 cases with laparoscopic cholecystectomy for gallstone disease and 80 healthy women without GSD. Genomic DNA samples were taken from blood to find the genotype of APOE using allele-specific sequence-primers and a method based on polymerase chain reaction (PCR). lipid profiles were examined using an automated biochemical analyzer. SPSS and GraphPad Prism 9.1.1 software were used to conduct the statistical analysis. No significant relationships were found between healthy people and GSD patients in genotype and allele frequencies. However, the genotype for E3/E4 and the APOE4 allele in GSD patients were higher than the controls (9.88% vs. 5.0% and 4.94% vs. 2.5%, respectively; P <0.05) but statistically nonsignificant. serum levels of cholesterol, low-density lipoproteins, and very low-density lipoproteins were higher, and the levels of serum high-density lipoprotein was lower than controls. These findings revealed no connection between the examined polymorphisms and gallstone cases. Additionally, it was demonstrated that gallstone disease and lipid parameters had a favorable relationship. Keywords: Apolipoprotein E, APOE, Gallstone disease, Genotype, Polymorphisms.

Liver biopsy in patients with gall stone disease and concomitant non-alcoholic fatty liver disease undergoing cholecystectomy: A prospective observational study

Objective: Gallstone disease (GSD) and non-alcoholic fatty liver disease (NAFLD) share common risk factors. NAFLD can progress to non-alcoholic steatohepatitis (NASH), which may lead to severe liver conditions. This study aimed to assess the prevalence of NASH and associated factors in patients with GSD and fatty liver undergoing cholecystectomy. Material and Methods: This prospective observational study was conducted from March 2021 to June 2023 and included 134 patients diagnosed with GSD and fatty liver based on preoperative ultrasound. Core liver biopsies were obtained during cholecystectomy. Preoperatively, clinical, anthropometric, demographic, biochemical variables, and FibroScan parameters were recorded. Results: NASH was found in 21 (15.67%) patients, while 50 (37.31%) patients had probable NASH, and 63 (47.01%) had non-NASH scores. Metabolic syndrome was present in 63.6% of the patients. Univariate analysis revealed significant differences in AST and ALT values between the NASH and nonNASH groups. In multivariate analysis, AST was statistically significant (p= 0.041). Mean controlled attenuation parameter in patients with non-NASH was 219.40 ± 60.44 dB/m, and in patients with NASH, it was 265.48 ± 63.47 dB/m (p= 0.006). Fibrosis was present in 33 of the 82 slides examined, with 17 patients having grade 2 and two patients with grade 3 fibrosis. Conclusion: The high prevalence of NASH among GSD patients highlights a significant public health issue, prompting consideration for liver biopsy in individuals with NAFLD and GSD undergoing laparoscopic cholecystectomy.

Significance of family history of cholelithiasis in a Pakistani population: A single center, descriptive cross-sectional study.

Linkage studies have indicated a potential genetic predisposition to cholelithiasis. This study aims to determine the frequency of positive family history of gallstone disease in patients presenting with gallstones in a Pakistani population. A descriptive, cross-sectional study was conducted at the surgical department of the University of Lahore Teaching Hospital from June 30, 2023 to August 30, 2023. A total of 102 radiologically confirmed cholelithiasis patients were enrolled. Out of 102 participants, 75.5% (n = 77) were females, with a mean age at presentation of 42.1 ± 12.1 years. The study found that 32.4% (n = 33) of participants had a single family member with gallstones, 3.9% (n = 4) had 2 family members affected, and 1% (n = 1) had 3 family members affected. The attributable risk of genetics from our study was 37.2%. Additionally, there was no significant association between positive family history and earlier onset of disease. A significant percentage of Pakistani population may have gallstone disease due to genetic factors.

Association between gallstone disease and carotid intima-media thickness: a prospective observational cross-sectional study in a tertiary care center.

Gallstone disease (GD) is a prevalent health issue globally, particularly in developed nations, and has notable associations with cardiovascular disease (CVD). This prospective observational cross-sectional study aimed to investigate the association between gallstone disease and carotid intima-media thickness (CIMT), a marker of carotid atherosclerosis, in a tertiary care setting. Conducted at a tertiary care center, the study included 96 participants (48 with gallstone disease and 48 age and sex-matched controls). Data collection involved demographic information, BMI calculation, abdominal ultrasonography for gallstone detection, and carotid ultrasonography for CIMT measurement. Statistical analysis was performed using SPSS version 26. The study revealed higher CIMT values in GD patients compared to controls (P<0.001). Additionally, a positive correlation was observed between CIMT and age (r=0.450, P<0.001) and BMI (r=0.550, P<0.001). The Cohen's d-test indicated a clinically significant difference in CIMT between GD patients and controls (d=1.47). This study revealed a significant association between gallstone disease and elevated CIMT, correlating with higher BMI indicating a potential link between gallstone disease and increased risk of carotid atherosclerosis. These findings highlight the importance of assessing cardiovascular risk in patients with gallstone disease, highlighting the potential utility of carotid ultrasonography as a non-invasive screening tool. Early intervention strategies may be warranted to mitigate cardiovascular risks associated with gallstone disease.

Prevalence of Gallstone Disease in Patients with Type 2 Diabetes in Port Harcourt, Nigeria: A Cross-Sectional Ultrasound Study

Prevalence of Gallstone Disease in Patients with Type 2 Diabetes in Port Harcourt, Nigeria: A Cross-Sectional Ultrasound Study

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease.

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

Prevalence of Thyroid Disorder in Gallstone Disease Patients: A Cross-Sectional Study.

Background Gallstone disease (GSD) is one of the most common disorders involving the biliary system. The three types of gallstones include pigment, cholesterol, and mixed stones. Studies have suggested a potential association between thyroid dysfunction and lipid pathogenesis, which influences bile composition. A higher prevalence of thyroid disorders may have an impact on the management of GSD patients. This study aimed to assess the prevalence of thyroid disorders and associated dyslipidemias among individuals diagnosed with GSD. Methodology This cross-sectional, observational study was conducted among 180 eligible patients with a mean age of 47.72 ± 15.29 years. This study included 56 (31%) male and 124 (69%) female patients admitted to the Department of General Surgery, Indira Gandhi Institute of Medical Sciences, in eastern India. A diagnosis of GSD was established based on a radiological investigation (ultrasonography) and was included in the study. A thyroid profile test, a liver function test, and a lipid profile test were done for all patients. Patients with a previous surgical history of thyroid disease and known cases of hypothyroidism taking thyroxin supplements for treatment, as well as uncontrolled diabetes mellitus and hypertension, were excluded from the study. Relevant data were collected and statistically analyzed. Results Among the 180 patients, 122 (67.77%) were euthyroid, 35 (19.44%) had subclinical hypothyroidism, 20 (11.11%) had clinical hypothyroidism, and three (1.66%) had hyperthyroidism. Out of a total of 55 hypothyroidism patients, 37 (67.27%) had dyslipidemias. Conclusions The prevalence of hypothyroidism in GSD was 30%, with a female predominance. Hypothyroidism is a specific risk factor for cholelithiasis, and all patients with GSD who have dyslipidemia should be evaluated for thyroid dysfunction.

Predictive value of bile acids as metabolite biomarkers for gallstone disease: A systematic review and meta-analysis.

The profiles of bile acids (BAs) in patients with gallstone disease (GSD) have been found to be altered markedly though in an inconsistent pattern. This study aims to characterize the variation of the BA profiles in GSD patients, thereby to discover the potential metabolite biomarkers for earlier detection of GSD. Literature search of eight electronic database in both English and Chinese was completed on May 11, 2023. The qualitative and quantitative reviews were performed to summarize the changes of BA profiles in GSD patients compared with healthy subjects. The concentrations of BAs were adopted as the primary outcomes and the weighted mean differences (WMDs) and 95% confidence interval (CI) were generated by random-effects meta-analysis models. A total of 30 studies were enrolled which included 2313 participants and reported the 39 BAs or their ratios. Qualitative review demonstrated serum Taurocholic Acid (TCA), Glycochenodeoxycholic acid (GCDCA), Glycocholic acid (GCA), Taurochenodeoxycholic acid (TCDCA), Glycodeoxycholic acid (GDCA) and Deoxycholic acid (DCA) were significantly increased in GSD patients compared with healthy subjects. Meta analysis was performed in 16 studies and showed that serum Total BAs (TBA) (WMD = 1.36μmol/L, 95%CI = 0.33; 2.4) was elevated however bile TBA (WMD = -36.96mmol/L, 95%CI = -52.32; -21.6) was declined in GSD patients. GCA (WMD = 0.83μmol/L, 95%CI = 0.06; 1.6) and TCA (WMD = 0.51μmol/L; 95%CI = 0.18; 0.85) were both increased in serum sample; TCDCA (WMD = 2.64mmol/L, 95%CI = 0.16; 5.12) was rising, however GCDCA (WMD = -13.82mmol/L, 95%CI = -21.86; -5.78) was falling in bile sample of GSD patients. The level of serum DCA in the GSD patients was found to be increased by using chromatography, yet decreased by chromatography mass spectrometry. The profiles of BAs demonstrated distinctive changes in GSD patients compared with healthy control subjects. Serum GCA, TCA and GCDCA, as the typically variant BAs, presented as a potential marker for earlier diagnosis of GSD, which could facilitate early prophylactic intervention. Yet, further validation of these biomarkers by longitudinal studies is still warranted in the future. PROSPERO registration number CRD42022339649.

Protein Phosphatase 1 Regulatory Subunit 3 Beta rs4240624 Genotype Is Associated With Gallstones and With Significant Changes in Bile Lipidome

Gallstone disease (GSD) associates with significant morbidity and mortality. Decreased secretion of bile acids has been suggested as a driving factor for GSD. Recently, we linked the protein phosphatase 1 regulatory subunit 3 beta (PPP1R3B) rs4240624 genotype to decreased bile acid levels in bile. In this study, we investigated whether these individuals had an increased risk for GSD as well as the differences in the lipid composition of the gallbladder bile of these individuals compared to controls and patients with GSD. Bile acids, cholesterol, and phospholipid levels in gallbladder bile samples were enzymatically measured in 46 patients (34 female, age 45.7 ± 9.8 years, BMI 41.3 ± 4.4 kg/m2) who underwent elective laparoscopic Roux-en-Y gastric bypass. The lipidome of gallbladder bile was analyzed using high-performance liquid chromatography-mass spectrometry. Gallstone status was evaluated using abdominal ultrasonography before the surgery. The G allele of PPP1R3B rs4240624 was significantly associated with GSD in patients with obesity. We validated this association in the UK Biobank. Bile lipidomics demonstrated that 13 of the 17 minor lipid classes measured were higher in individuals with the G allele. The concentrations of bile acids, cholesterol, and phospholipids, as well as the cholesterol saturation index, were lower in patients with GSD than in those without gallstones. GSD had an effect similar to that of PPP1R3B genotype on minor lipids. The PPP1R3B rs4240624 genotype is associated with gallstones and with changes in gallbladder bile similar to those observed in patients with gallstones, suggesting that the PPP1R3B genotype contributes to the risk of gallstones by altering the bile lipidome.

Patient-reported Outcome Measure (PROM) Rand-36-item Health Survey for Gallstone Disease Patients Five Years Following Surgery: A Prospective Randomized Study.

There are no studies assessing the long-term quality of life (QoL) following three-dimensional laparoscopy cholecystectomy (3D-LC) in patients with cholelithiasis (Chole). A cohort of 200 patients with Chole were randomized into 3D-LC or minilaparotomy cholecystectomy (MC) groups. RAND-36 survey was performed before randomization, four weeks and five years postoperatively. Similar postoperative five years RAND-36 scores were reported in the 3D-LC and MC groups. The MC and 3D-LC groups combined analysis, social functioning (SF, p=0.007), mental health (MH, p=0.001), role physical (RP, p<0.001) and bodily pain (BP, p<0.001) domains increased significantly. In comparison to the Finnish reference RAND-36 (FRR) scores, the scores at five years increased significantly in the MH domain, while four RAND-36 domains; Physical functioning (PF), general health (GH), RP, BP remained significantly lower in comparison to the FRR scores. A relatively similar long-term outcome in the 3D-LC and MC patients is shown. Interestingly, five RAND-36 domains increased during five years follow-up, while four RAND-36 domains remained lower than FRR scores, which may indicate onset of possible new symptoms following cholecystectomy in long-term follow-up.

Clinical Significance of Frequently Down-Regulated Phosphatidylethanolamine-Binding Protein-1 in Gallbladder Cancer.

Promoter hypermethylation of tumor suppressor genes has been demonstrated to be one of the major mechanisms of their epigenetic regulation in various reports. We have studied the promoter methylation status of PEBP1 and evaluated its correlation with gallbladder carcinogenesis. PEBP1, an endogenous inhibitor of Raf/MEK/ERK signaling pathway, is a tumor suppressor gene. We aimed to study the expression profile of PEBP1 and understand the mechanism and significance of its deregulation in gallbladder cancer. PEBP1 expression analysis and its promoter methylation status were investigated in 77 gallbladder carcinoma (GBC) and tissue biopsies from 28 patients of gallstone disease by RT-PCR and MS-PCR, respectively. Our results of the mRNA expression profiling demonstrate that PEBP1 is down-regulated in 62.3% (48/77), while 31.2% (24/77) of the gallbladder cancer biopsies show no significant change and 6.5% (5/77) show up-regulated expression compared to tissue samples of gallstone diseases. In GBC, 48.1% (N = 37) GBC biopsy samples exhibited significantly heterozygous promoter hypermethylation compared to tissue samples from gallstone diseases which show promoter hypermethylation in 3 (10.7%) samples only. In gallbladder cancer, the PEBP1 methylation is significantly associated with lymph node metastasis and shorter period of survival. PEBP1 is frequently down-regulated and hypermethylated in gallbladder cancer and its promoter hypermethylation is a frequent and early inactivating mechanism in GBC.

Risk of Gallstone Disease in Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

ObjectiveApart from renal stones, primary hyperparathyroidism (PHPT) has been linked to the occurrence of gallstone disease (GSD). Nevertheless, the association is not consistent across all studies. The present systematic review and meta-analysis aims to collate the hitherto available evidence and provide a pooled estimate of the association between GSD and PHPT. MethodsPubMed/MEDLINE, Embase, and Web of Science databases were systematically searched from inception till May 10, 2023 for observational studies reporting the prevalence of GSD (in terms of absolute numbers) in patients with PHPT. The pooled prevalence of GSD and odds ratio with 95% CI of the occurrence of GSD in patients with PHPT as compared to age- and sex-matched controls were calculated. Subgroup analysis was performed based on patient ethnicity (Indian/Caucasian). Statistical analysis was carried out using R version 4.2.2. Random-effects model with Hartung-Knapp adjustment was used for analyses. ResultsA total of 7 observational studies were included, pooling data from 15 949 patients with PHPT. The pooled prevalence of GSD in patients with PHPT was 16% (95% CI: 7%, 25%, I2 = 99%), being 13% (95% CI: 0%, 66%, I2 = 76%) in Indians, and 17% (95% CI: 4%, 31%, I2 = 99%) in Caucasians. Data consolidated from 3 studies showed that the pooled odds ratio of occurrence of GSD in patients with PHPT compared to controls was 1.77 (95% CI: 1.60, 1.97, P < .001, I2 = 0%). ConclusionsGSD is more prevalent in patients with PHPT than in the general population. Thus, PHPT may be considered an additional risk factor for GSD.

OGBN P03 Surgeons’ perceptions of elective laparoscopic cholecystectomy in the post-COVID era

Abstract Background The COVID-19 pandemic has significantly impacted healthcare systems worldwide, leading to modifications in surgical practices. Laparoscopic cholecystectomy (LC), a common elective procedure, has faced challenges in the post-COVID era, with increased waiting times and episodes of acute gallstone disease in patients awaiting their procedure. This poses the question as to whether modifications to routine practice should be made. This study aims to explore surgeons' perceptions on performing laparoscopic cholecystectomy in the current post-pandemic landscape. Methods An anonymous survey was conducted among general surgeons with expertise in LC across multiple healthcare institutions nationally. The survey included questions relating to surgeons’ speciality, and their experience with elective LCs, intraoperative cholangiograms (IOC) and laparoscopic common bile duct exploration (LCBDE) in post-COVID era. Further opinions were sought on complicated intraoperative findings, rate of aborting procedure, rate of conversion to open and number of elective LCs completed by trainees. The data obtained was analysed using descriptive statistics and Fisher’s exact test for statistical significance calculations. Results 40 surgeons with varying levels of experience with LC completed the survey: 8 (20%) &amp;lt;50, 16 (40%) 100-500 LCs,10 (25%) 500-&amp;gt;1000. Overall, 21 (53%) perceived LC to be more challenging. Analysis between the different groups found no significant difference (p = 0.68) between those who performed &amp;lt;50 LCs (6/8) and 500- &amp;gt;1000 LCs (6/10). 8 (20%) respondents found no increase in complicated intraoperative findings. Of those not working in specialist centres, 11/36 perceived an increase in referral to a hepatobiliary unit. 14 (35%) perceived an increase in unplanned admission. 21 (53%) perceived a reduction in completion of LC by trainees. Conclusions This study demonstrates that a significant proportion of respondents believe that LC has become more technically challenging. In patients with increased time till surgery or episodes of acute gallstone disease, MRCP should be considered at pre-assessment. Furthermore, during challenging LCs, options to ‘bail-out’ or convert to open should be considered. This study also raises awareness on the reduction in training opportunities and the need to ensure trainees progress appropriately. Limitations include small sample size and subjective nature of responses. Further research on patient outcomes is required to provide strong recommendations to optimise surgical practice of LC in the post-pandemic era.

Dietary inflammatory index and risk of gallstone disease in Iranian women: a case-control study

BackgroundConsidering inflammation as a primary occurrence in gallstone formation, this study aimed to determine the relation between serum biomarkers of inflammation and oxidative stress, and dietary Inflammatory Index (DII) score with the risk of gallstone disease (GD) among Iranian women.Materials and methodsPresent BMI-matched case-control study was performed among 75 women with GD and 75 healthy controls. Biochemical parameters were measured by standard laboratory methods. A validated food frequency questionnaire (FFQ) was used to assess the usual intake of participants. DII score was calculated for all participants. The linear and logistic regression were used to examine the association of DII with serum inflammatory biomarkers and the odds ratio of GD, respectively.ResultsThe mean serum levels of high-sensitivity C-reactive protein (hs-CRP) and Malondialdehyde (MDA) were significantly (P < 0.001) higher in GD patients compared to control subjects. Women in the highest tertile of DII compared to the lowest tertile had lower intake of macronutrients, minerals, vitamins garlic, onion, pepper and fiber. Moreover, the odd of GD was significantly higher in the third tertile of the DII versus the first tertile after adjustment of potential confounders (OR: 17.47; 95% CI: 4.64–65.72). Also, a positive and significant relationship was found between the serum level of inflammatory biomarkers with the risk of GD and the inflammatory score of the diet (P < 0.001).ConclusionOur data indicate that higher DII score, and serum inflammatory and oxidative stress biomarkers are related to higher risk of GD in Iranian women.

Correlation of serum biochemical characteristics and ABCG8 genetic variant (rs 11887534) with gall stone compositions and risk of gallstone disease in a group of Egyptian patients.

The overexpression of the cholesterol transporter: ATP-binding cassette transporter (ABCG8) due to the effect of ABCG8 genetic variant (rs11887534) leads to the precipitation of cholesterol crystals and gallstone disease (GSD). To evaluate the chemical composition of gallstones and the role of ABCG8 (rs11887534) in the susceptibility to GSD. We enrolled 77 patients with GSD treated with standard laparoscopic or open cholecystectomy and 75 age and sex-matched healthy controls. Chemical analysis of the extracted gallstones was performed. Analysis of the rs11887534 was performed by real-time PCR TaqMan technique for both cases and controls. Pure cholesterol stones were the main type of stones in GSD patients. The CC genotype carriers of rs11887534 were more prone to gallstone formation than other genotypes. The CC genotype carriers were 100 folds at increased risk to develop pure cholesterol stones. The most prevalent type of gallbladder stones is pure cholesterol stone. ABCG8 (rs11887534) could be associated with increased risk for cholesterol gallstones formation, this risk was more pronounced in female patients.

Identification of Intestinal Microbial Community in Gallstone Patients with Metagenomic Next-Generation Sequencing.

Gallstone disease (GD) is one of the most common gastrointestinal diseases worldwide. Nowadays, intestinal microbiota are thought to play important roles in the formation of gallstones. In our study, human fecal samples were extracted for metagenomic next-generation sequencing (mNGS) on the Illumina HiSeq platform, followed by bioinformatics analyses. Our results showed that there was a particular intestinal micro-ecosystem in GD patients. In contrast to healthy people, the sequences of Bacteroidetes, Bacteroides and Thetaiotaomicron were obviously more abundant in GD patients at phylum, genus and species levels, respectively. On the other hand, the glycan metabolism and drug resistance, especially for the β-lactams, were the most profound functions of gut microbes in GD patients compared to those in normal subjects. Furthermore, a correlation analysis drew out that there existed a significant relationship between the serum levels of biochemical indicators and abundances of intestinal microbes in GD patients. Our results illuminate both the composition and functions of intestinal microbiota in GD patients. All in all, our study can broaden the insight into the potential mechanism of how gut microbes affect the progression of gallstones to some extent, which may provide potential targets for the prevention, diagnosis or treatment of GD.

Role of Morphology and Immunohistochemistry in the Diagnosis of Incidental Cancers in Gallstone Disease

Introduction: The majority of gallbladder adenocarcinomas have been known to develop from dysplasia or carcinoma in situ, without pre-existing adenomas, hence observation of these non-neoplastic or preneoplastic lesions is important as it may underlie an occult malignancy. To study the role of morphology and immunohistochemistry in the diagnosis of incidental cancers in cases of gall stone disease by adopting a universal histopathological screening policy for all the gallstone disease cases operated at our tertiary care center. Material and Methods: The present study was designed as an observational cross sectional study completed over a time period of 14 months. A total of 176 cases were included in the study including all the patients of gall stone disease in the adult age group. All the indeterminate and frankly malignant cases were subjected to immunohistochemistry with a panel of antibody markers including p53, CEA and Ki-67 using Streptavidin Biotin immunoperoxidase method Fisher-exact test was used to compare the data taking‘p’ value less than 0.05 as statistically significant. Results: Mean age of patients was 40.55±13.25 years. Majority of patients (n=141; 80.1%) were females. The final diagnosis revealed a dominance of non-neoplastic inflammatory (n=168; 95.5%) pathology. There were 8 (4.5%) of malignancy, of these 7 were adenocarcinoma and 1 was adenosquamous carcinoma. Atypia was seen in 5 (2.8%) cases and 3 (1.7%) cases were of dysplasia. Histopathology detected carcinoma in 7 (4%) cases whereas addition of immunohistochemistry helped to find out one more unidentified case, thus the diagnostic yield increased to 8 (4.5%) cases. Out of three dysplasia cases, one (33.3%) was found positive on immunohistochemistry, which was later confirmed to be malignant. None of the cases of atypia were positive on p53, Ki-67 and CEA immunohistochemistry. On comparison between the three groups, the results were statistically significant (p=0.00062). Conclusion: Immunohistochemistry has a useful role in detection of incidental gallbladder carcinoma when morphology is limited by indeterminate results. A panel of immunohistochemical markers including p53, Ki-67 and CEA may prove very useful to pick up cases of malignancy in such cases of diagnostic dilemma.

Frequency of Gallstones in Fatty Liver disease in a Tertiary Care of Suburban Islamabad

Background: Gallstone disease and Non-Alcoholic Fatty Liver Disease (NAFLD) share common etiological pathways. The objective of this study was to determine the frequency of Gallstones and Non-Alcoholic Fatty Liver disease (NAFLD) in patients undergoing abdominal ultrasounds in our hospital and to compare the frequency of Gallstone disease in patients with NAFLD and without NAFLD.&#x0D; Methodology: This cross-sectional study was carried out at HBS General Hospital, Islamabad from January 2020 till December 2020. Patients undergoing routine ultrasounds in the out-patient department of the hospital were included in the study. Patients having Emergency Ultrasounds, history of Alcohol intake, history of chronic liver disease and pregnant patients were excluded from the study. Data was analysed using Microsoft Excel 2016 and IBM SPSS 22.&#x0D; Results: A total of 689 patients were included with a 3:1 Female to Male ratio. Mean Age was 40.65± 15.610 years. The prevalence of Gallstone disease was found to be 20.9% while that of NAFLD 27.6%. A higher percentage of patients with NAFLD had Gallstones as compared to those who did not have NAFLD (24.2% vs 19.6% respectively) however for overall data, statistical significance was not reached. A statistically significant greater number of young patients with NAFLD had Gallstones as compared to those who did not have NAFLD (50% vs 6%, p&lt;0.001). Mean age was greater in patients who had NAFLD as well as those having Gallstones.&#x0D; Conclusion: The frequency of Gallstones was greater in patients with NAFLD as compared to those without NAFLD.&#x0D; Keywords: Cholelithiasis, Fatty Liver Disease, Gallstones, Non-Alcoholic, Ultrasonogram&#x0D;

CORRELATION OF PRE OPERATIVE AND INTRA OPERATIVE FINDINGS IN GALL STONE DISEASE

Background: Gallstone disease (GD) is a chronic recurrent hepatobiliary disease, the basis for which is the impaired metabolism of cholesterol, bilirubin and bile acids which is characterized by the formation of gallstones in the hepatic bile duct, common bile duct or gallbladder. GD is one of the most prevalent gastrointestinal diseases with a substantial burden to health care systems. GD can result in serious outcomes such as acute gallstone pancreatitis and gallbladder cancer. The epidemiology, correlation with USG ndings and anatomical variants encountered during cholecystectomy are discussed in this study. To compare preoperative and intraope Aims and objectives: rative ndings of gall stone disease in patients who underwent cholecystectomy. 104 patients who underwent cholecystect Materials and methods: omy in Kanyakumari Government Medical College from January 2019 to December 2022. Majority of the patients were Results: in age group between 19 to 78 years of age with a mean age of 42.5. Female predominance was reported in our study comprising 65% of total study participants. The study identied a sensitivity of 0.84 and a specicity of 1 for ultrasound in the identication of gallstones.10 % of the study population had different anatomical variants which were encountered during cholecystectomy. &lt;4% of study population was intraoperatively converted from laparoscopic to open cholecystectomy. 78% of stones are pigment stones based on dry weight analysis. Reproductive Age and fe Summary: male sex are profoundly associated with the incidence of gallstone disease. This study suggests that despite an evolution in the resolution of ultrasound imaging, there has not been a corresponding improvement in sensitivity. Knowledge of Variation in cystic duct anatomy is important to avoid inadvertent injury to the biliary tree during Cholecystectomy. The study population have a predominance of pigment stones based on dry weight analysis

Clinical and pathological profile of Gallbladder Cancer (GBC) and Gallstone disease GSD) among the patients admitted in tertiary care institute in Kolkata

Background: Gallstone disease (GSD) is one of the most common surgical problems throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Gall bladder cancer (GBC) is a common cancer in the northern and North-eastern States of India. The six cancer registries of the Indian Council of Medical Research (ICMR) (1990-1996) show a 10 times lower incidence of GBC per 1 00 000 in South India compared with the North. The objective of present study was to assess the epidemiological and pathological profile of GSD and GBC patients of Eastern India visiting tertiary care hospital of Kolkata.Method: This cross-sectional observational study was conducted, over a period of 18 months, at a tertiary referral hospital of Kolkata. In this study, 66 gallstone disease patients and 24 gallbladder cancer patients who undergone surgery were included in the study after their written informed consent. Data on their demographic and pathological profile, type of gallstones, their number and staging and type gallbladder cancer were collected. Results: GSD GBC were found to afflict females, Male to female ratio was 1:2 1:3 for GSD and GBC respectively. We found that nearly half (45.4%) GSD patients were in the age group of 21-40 years and more than half (58.6%) GBC patients were in age group of 41-60 years. Majority of GSD patients had multiple stones (57.6%) and cholesterol stones were most common (59.1%). Out of 24 GBC patients, nearly one-third (33.3%) had stage II cancer and only 12.5% patients had stage IV cancer. More than one-fourth (29.2%) GBC patients had poorly differentiated carcinoma.Conclusion: The results of this study reaffirm that female gender is a strong predisposing factor for GSD and GBC and patients in their fourth decade, are more at risk. Large population based multicentric analytical study is necessary to strengthen this study findings.