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Aziz H, Hewitt DB, Pawlik TM. Critical Analysis of the Updated Guidelines for Management of Gallbladder Polyps. Ann Surg Oncol 2022; 29:3363-3365. [PMID: 35419760 DOI: 10.1245/s10434-022-11701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/18/2022]
Affiliation(s)
| | - D Brock Hewitt
- The Ohio State Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Surgery, Oncology, Health Services Management and Policy, Columbus, USA.
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Foley KG, Lahaye MJ, Thoeni RF, Soltes M, Dewhurst C, Barbu ST, Vashist YK, Rafaelsen SR, Arvanitakis M, Perinel J, Wiles R, Roberts SA. Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol 2021; 32:3358-3368. [PMID: 34918177 PMCID: PMC9038818 DOI: 10.1007/s00330-021-08384-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Abstract Main recommendations Primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound. Routine use of other imaging modalities is not recommended presently, but further research is needed. In centres with appropriate expertise and resources, alternative imaging modalities (such as contrast-enhanced and endoscopic ultrasound) may be useful to aid decision-making in difficult cases. Strong recommendation, low–moderate quality evidence. Cholecystectomy is recommended in patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery. Multidisciplinary discussion may be employed to assess perceived individual risk of malignancy. Strong recommendation, low-quality evidence. Cholecystectomy is suggested for patients with a polypoid lesion and symptoms potentially attributable to the gallbladder if no alternative cause for the patient’s symptoms is demonstrated and the patient is fit for, and accepts, surgery. The patient should be counselled regarding the benefit of cholecystectomy versus the risk of persistent symptoms. Strong recommendation, low-quality evidence. If the patient has a 6–9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery. These risk factors are as follows: age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). Strong recommendation, low–moderate quality evidence. If the patient has either no risk factors for malignancy and a gallbladder polypoid lesion of 6–9 mm, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year and 2 years. Follow-up should be discontinued after 2 years in the absence of growth. Moderate strength recommendation, moderate-quality evidence. If the patient has no risk factors for malignancy, and a gallbladder polypoid lesion of 5 mm or less, follow-up is not required. Strong recommendation, moderate-quality evidence. If during follow-up the gallbladder polypoid lesion grows to 10 mm, then cholecystectomy is advised. If the polypoid lesion grows by 2 mm or more within the 2-year follow-up period, then the current size of the polypoid lesion should be considered along with patient risk factors. Multidisciplinary discussion may be employed to decide whether continuation of monitoring, or cholecystectomy, is necessary. Moderate strength recommendation, moderate-quality evidence. If during follow-up the gallbladder polypoid lesion disappears, then monitoring can be discontinued. Strong recommendation, moderate-quality evidence.
Source and scope These guidelines are an update of the 2017 recommendations developed between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery–European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). A targeted literature search was performed to discover recent evidence concerning the management and follow-up of gallbladder polyps. The changes within these updated guidelines were formulated after consideration of the latest evidence by a group of international experts. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Key Point • These recommendations update the 2017 European guidelines regarding the management and follow-up of gallbladder polyps.
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Affiliation(s)
- Kieran G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK.
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruedi F Thoeni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco Medical School, San Francisco, CA, USA
| | - Marek Soltes
- 1st Department of Surgery LF UPJS a UNLP, Kosice, Slovakia
| | - Catherine Dewhurst
- Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Sorin Traian Barbu
- 4th Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Yogesh K Vashist
- Clinics of Surgery, Department General, Visceral and Thoracic Surgery, Asklepios Goslar, Germany
| | - Søren Rafael Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, University of Southern Denmark, Odense M, Denmark
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital ULB, Brussels, Belgium
| | - Julie Perinel
- Department of Hepatobiliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France
| | - Rebecca Wiles
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Halligan S, Tolan D, Amitai MM, Hoeffel C, Kim SH, Maccioni F, Morrin MM, Mortele KJ, Rafaelsen SR, Rimola J, Schmidt S, Stoker J, Yang J. ESGAR consensus statement on the imaging of fistula-in-ano and other causes of anal sepsis. Eur Radiol 2020; 30:4734-4740. [PMID: 32307564 PMCID: PMC7431441 DOI: 10.1007/s00330-020-06826-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Objectives To develop imaging guidelines for patients with fistula-in-ano and other causes of anal sepsis. Methods An expert group of 13 members of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) used a modified Delphi process to vote on a series of consensus statements relating to the imaging of patients with potential anal sepsis. Participants first completed a questionnaire to gather practice information and to help frame the statements posed. Results In the first round of voting, the expert group scored 51 statements of which 45 (88%) achieved immediate consensus. The remaining 6 statements were redrafted following input from the expert group and consensus achieved for all during a second round of voting, including an additional statement drafted. No statement was rejected due to a lack of consensus. After redrafting to improve clarity, 53 individual statements were presented. Conclusion These expert consensus statements can be used to guide appropriate indication, acquisition, interpretation and reporting of medical imaging for patients with potential fistula-in-ano and other causes of anal sepsis. Key Points • Medical imaging, notably magnetic resonance imaging, is used widely for the diagnosis and monitoring of fistula-in-ano and other causes of anal and perianal sepsis. • While the indexed medical literature is clear that diagnostic accuracy is potentially excellent, this depends on competent image acquisition and interpretation. • In order to facilitate this, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) has produced expert consensus guidelines regarding the imaging of fistula-in-ano and related conditions. Electronic supplementary material The online version of this article (10.1007/s00330-020-06826-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - D Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - M M Amitai
- Department of Radiology, Sackler Faculty of Medicine, Tel Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, Reims, France
| | - S H Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - F Maccioni
- Department of Radiological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K J Mortele
- Division of Abdominal Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S R Rafaelsen
- Colorectal Centre of Excellence, University Hospital of Southern Denmark, Vejle, Denmark
| | - J Rimola
- Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S Schmidt
- Department of Radiology, University Hospital, CHUV, Lausanne, Switzerland
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Yang
- Department of Radiology, Concord Hospital, Sydney, Australia
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