Ann Hepatobiliary Pancreat Surg.  2016 Nov;20(4):180-186. 10.14701/ahbps.2016.20.4.180.

Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder

• Lee H
• Kim K
• Park I
• Cho H
• Gwak G
• Yang K
• Bae BN
• Kim HJ
• Kim YD

• KMID: 2362468
• DOI: http://doi.org/10.14701/ahbps.2016.20.4.180

Abstract

BACKGROUNDS/AIMS
We investigated patients' clinical and radiological data to determine preoperative factors that predict cholesterol gallbladder (GB) polyps of large size, which can be helpful for decision on further diagnostic tools.
METHODS
In this study, we retrospectively analyzed 126 patients who underwent laparoscopic cholecystectomy for GB polyps >10 mm diagnosed preoperatively by abdominal ultrasonography between February 2002 and February 2016 in Department of Surgery, Sanggye Paik Hospital. Patients were divided into non-cholesterol polyps group and cholesterol polyps group, based on the postoperative pathologic diagnosis. Clinical and radiological data, such as gender, age, body weight, height, body mass index (BMI), laboratory findings, size, number and shape of the polypoid lesions, and presence of the concurrent GB stone were compared between the two groups.
RESULTS
Of the 126 cases, 73 had cholesterol polyps (57.9%) and 53 cases were non-cholesterol polyps (42.1%). The younger age (<48.5 years), size of polyp <13.25 mm and multiple polyps were independent predictive variables for cholesterol polyps, with odd ratios (OR) of 2.352 (p=0.045), 5.429 (p<0.001) and 0.472 (p<0.001), respectively.
CONCLUSIONS
Age, size and polyp number were used to predict cholesterol GB polyp among polypoid lesions of the gallbladder >10 mm. For cases in which these factors are not applicable, it is strongly recommended to evaluate further diagnostic tools, such as computed tomography, endoscopic ultrasonography and tumor markers.

Keyword

Gallbladder; Polyps; Cholesterol; Laparoscopic cholecystectomy

MeSH Terms

Biomarkers, Tumor
Body Height
Body Weight
Cholecystectomy, Laparoscopic*
Cholesterol*
Diagnosis
Endosonography
Gallbladder*
Humans
Polyps*
Retrospective Studies
Ultrasonography
Biomarkers, Tumor
Cholesterol

Figure

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  Fig. 1 A diagram of the patients' enrollment. GB, gallbladder.

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  Fig. 2 Reciever-operator characteristic curve of the sonographic size of the polypoid lesions of the gallbladder.

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  Fig. 3 Reciever-operator characteristic curve of age of the polypoid lesions of the gallbladder.

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. PMID: 9362194.

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. PMID: 1595653.

3. Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg. 2009; 33:2657–2663. PMID: 19823903.

4. 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. PMID: 12471539.

5. 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. PMID: 11248179.

6. Terzi C, Sökmen S, Seçkin S, Albayrak L, Uğurlu M. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery. 2000; 127:622–627. PMID: 10840356.

7. Zielinski MD, Atwell TD, Davis PW, Kendrick ML, Que FG. Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics. J Gastrointest Surg. 2009; 13:19–25. PMID: 18972168.

8. 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. PMID: 11685029.

9. Ito H, Hann LE, D'Angelica M, Allen P, Fong Y, Dematteo RP, et al. Polypoid lesions of the gallbladder: diagnosis and followup. J Am Coll Surg. 2009; 208:570–575. PMID: 19476792.

10. Kar M, Bhattacharyya U, Laha RN, Saha I, Mukhopadhyay M. Haemobilia due to a large gall bladder polyp. J Indian Med Assoc. 2003; 101:554–555. PMID: 15168995.

11. Damore LJ 2nd, Cook CH, Fernandez KL, Cunningham J, Ellison EC, Melvin WS. Ultrasonography incorrectly diagnoses gallbladder polyps. Surg Laparosc Endosc Percutan Tech. 2001; 11:88–91. PMID: 11330390.

12. Matos AS, Baptista HN, Pinheiro C, Martinho F. Gallbladder polyps: how should they be treated and when? Rev Assoc Med Bras (1992). 2010; 56:318–332. PMID: 20676540.

13. 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. PMID: 10968853.

14. Furukawa H, Kosuge T, Shimada K, Yamamoto J, Kanai Y, Mukai K, et al. Small polypoid lesions of the gallbladder: differential diagnosis and surgical indications by helical computed tomography. Arch Surg. 1998; 133:735–739. PMID: 9688001.

15. Ching BH, Yeh BM, Westphalen AC, Joe BN, Qayyum A, Coakley FV. CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol. 2007; 189:62–66. PMID: 17579153.

16. Jang JY, Kim SW, Lee SE, Hwang DW, Kim EJ, Lee JY, et al. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg. 2009; 250:943–949. PMID: 19855259.

17. Cheon YK, Cho WY, Lee TH, Cho YD, Moon JH, Lee JS, et al. Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps. World J Gastroenterol. 2009; 15:2361–2366. PMID: 19452579.

18. Lee KF, Wong J, Li JC, Lai PB. Polypoid lesions of the gallbladder. Am J Surg. 2004; 188:186–190. PMID: 15249249.

19. Okamoto M, Okamoto H, Kitahara F, Kobayashi K, Karikome K, Miura K, et al. Ultrasonographic evidence of association of polyps and stones with gallbladder cancer. Am J Gastroenterol. 1999; 94:446–450. PMID: 10022644.

20. 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. PMID: 11444747.

21. Jørgensen T, Jensen KH. Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol. 1990; 25:281–286. PMID: 2320947.

22. Sahlin S, Granström L, Gustafsson U, Ståhlberg D, Backman L, Einarsson K. Hepatic esterification rate of cholesterol and biliary lipids in human obesity. J Lipid Res. 1994; 35:484–490. PMID: 8014583.

23. 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. PMID: 16484961.

24. Yang HL, Sun YG, Wang Z. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg. 1992; 79:227–229. PMID: 1555088.

25. 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. PMID: 16534690.

26. 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. PMID: 3276295.

27. Mainprize KS, Gould SW, Gilbert JM. Surgical management of polypoid lesions of the gallbladder. Br J Surg. 2000; 87:414–417. PMID: 10759734.

28. Park JY, Hong SP, Kim YJ, Kim HJ, Kim HM, Cho JH, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol. 2009; 24:219–222. PMID: 19054258.

29. Bang S. Natural course and treatment strategy of gallbladder polyp. Korean J Gastroenterol. 2009; 53:336–340. PMID: 19556839.

30. Pedersen MR, Dam C, Rafaelsen SR. Ultrasound follow-up for gallbladder polyps less than 6 mm may not be necessary. Dan Med J. 2012; 59:A4503. PMID: 23158888.

31. Kwon W, Jang JY, Lee SE, Hwang DW, Kim SW. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci. 2009; 24:481–487. PMID: 19543513.

32. Pejić MA, Milić DJ. Surgical treatment of polypoid lesions of gallbladder. Srp Arh Celok Lek. 2003; 131:319–324. PMID: 14692147.

33. Ishikawa O, Ohhigashi H, Imaoka S, Nakaizumi A, Kitamura T, Sasaki Y, et al. The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder. Am J Gastroenterol. 1989; 84:1386–1390. PMID: 2683741.

34. Park JK, Yoon YB, Kim YT, Ryu JK, Yoon WJ, Lee SH, et al. Management strategies for gallbladder polyps: is it possible to predict malignant gallbladder polyps? Gut Liver. 2008; 2:88–94. PMID: 20485616.