J Korean Surg Soc.  2012 Apr;82(4):232-237. 10.4174/jkss.2012.82.4.232.

Clinical and radiologic preoperative predicting factors for GB cholesterol polyp

• Song HL
• Shin JH
• Kim H
• Park YL
• Yoo CH
• Son BH
• Yoon JS
• Kim HO

• KMID: 1820071
• DOI: http://doi.org/10.4174/jkss.2012.82.4.232

Abstract

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

Keyword

GB polyp; Cholesterol polyp; Cholecystectomy; Radiologic study; Gallbladder

MeSH Terms

Body Height
Body Weight
Cholecystectomy
Cholesterol
Gallbladder
Humans
Leukocytes
Polyps
Urinary Bladder
Cholesterol

Reference

1. Chen CY, Lu CL, Chang FY, Lee SD. Risk factors for gallbladder polyps in the Chinese population. Am J Gastroenterol. 1997. 92:2066–2068.

2. Segawa K, Arisawa T, Niwa Y, Suzuki T, Tsukamoto Y, Goto H, et al. Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am J Gastroenterol. 1992. 87:630–633.

3. Onoyama H, Yamamoto M, Takada M, Urakawa T, Ajiki T, Yamada I, et al. Diagnostic imaging of early gallbladder cancer: retrospective study of 53 cases. World J Surg. 1999. 23:708–712.

4. Lee KF, Wong J, Li JC, Lai PB. Polypoid lesions of the gallbladder. Am J Surg. 2004. 188:186–190.

5. Jorgensen T. Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut. 1989. 30:528–534.

6. Barbara L, Sama C, Morselli Labate AM, Taroni F, Rusticali AG, Festi D, et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology. 1987. 7:913–917.

7. Sadamoto Y, Oda S, Tanaka M, Harada N, Kubo H, Eguchi T, et al. A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder, utilizing an endoscopic ultrasound scoring system. Endoscopy. 2002. 34:959–965.

8. Azuma T, Yoshikawa T, Araida T, Takasaki K. Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography. Am J Surg. 2001. 181:65–70.

9. Choi WB, Lee SK, Kim MH, Seo DW, Kim HJ, Kim DI, et al. A new strategy to predict the neoplastic polyps of the gallbladder based on a scoring system using EUS. Gastrointest Endosc. 2000. 52:372–379.

10. Sugiyama M, Xie XY, Atomi Y, Saito M. Differential diagnosis of small polypoid lesions of the gallbladder: the value of endoscopic ultrasonography. Ann Surg. 1999. 229:498–504.

11. Koga A, Watanabe K, Fukuyama T, Takiguchi S, Nakayama F. Diagnosis and operative indications for polypoid lesions of the gallbladder. Arch Surg. 1988. 123:26–29.

12. Shinkai H, Kimura W, Muto T. Surgical indications for small polypoid lesions of the gallbladder. Am J Surg. 1998. 175:114–117.

13. Yeh CN, Jan YY, Chao TC, Chen MF. Laparoscopic cholecystectomy for polypoid lesions of the gallbladder: a clinicopathologic study. Surg Laparosc Endosc Percutan Tech. 2001. 11:176–181.

14. Terzi C, Sokmen S, Seckin S, Albayrak L, Ugurlu M. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery. 2000. 127:622–627.

15. Jorgensen T, Jensen KH. Polyps in the gallbladder: a prevalence study. Scand J Gastroenterol. 1990. 25:281–286.

16. Sahlin S, Granström L, Gustafsson U, Stählberg D, Backman L, Einarsson K. Hepatic esterification rate of cholesterol and biliary lipids in human obesity. J Lipid Res. 1994. 35:484–490.

17. Sandri L, Colecchia A, Larocca A, Vestito A, Capodicasa S, Azzaroli F, et al. Gallbladder cholesterol polyps and cholesterolosis. Minerva Gastroenterol Dietol. 2003. 49:217–224.

18. Doh YW, Lee JH, Lim HM, Chi KC, Park YG. Polypoid lesions of gallbladder: clinicopathological features and indication of operation. J Korean Surg Soc. 2005. 69:245–251.

19. Akatsu T, Aiura K, Shimazu M, Ueda M, Wakabayashi G, Tanabe M, et al. Can endoscopic ultrasonography differentiate nonneoplastic from neoplastic gallbladder polyps? Dig Dis Sci. 2006. 51:416–421.

20. Mainprize KS, Gould SW, Gilbert JM. Surgical management of polypoid lesions of the gallbladder. Br J Surg. 2000. 87:414–417.

21. Yang HL, Sun YG, Wang Z. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg. 1992. 79:227–229.

22. Pandey M, Sood BP, Shukla RC, Aryya NC, Singh S, Shukla VK. Carcinoma of the gallbladder: role of sonography in diagnosis and staging. J Clin Ultrasound. 2000. 28:227–232.

23. Levy AD, Murakata LA, Abbott RM, Rohrmann CA Jr. From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation: Armed Forces Institute of Pathology. Radiographics. 2002. 22:387–413.

24. Csendes A, Burgos AM, Csendes P, Smok G, Rojas J. Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Ann Surg. 2001. 234:657–660.

25. Sugiyama M, Atomi Y, Yamato T. Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut. 2000. 46:250–254.

26. Kim SJ, Lee JM, Lee JY, Choi JY, Kim SH, Han JK, et al. Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. AJR Am J Roentgenol. 2008. 190:74–80.

27. Sadamoto Y, Kubo H, Harada N, Tanaka M, Eguchi T, Nawata H. Preoperative diagnosis and staging of gallbladder carcinoma by EUS. Gastrointest Endosc. 2003. 58:536–541.

28. Weaver SR, Blackshaw GR, Lewis WG, Edwards P, Roberts SA, Thomas GV, et al. Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer. Clin Radiol. 2004. 59:499–504.

29. Boulton RA, Adams DH. Gallbladder polyps: when to wait and when to act. Lancet. 1997. 349:817.

30. Ilias EJ. Gallbladder polyps: how should they be treated and when? Rev Assoc Med Bras. 2010. 56:258–259.