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Zhao H, Chen Y, Zhang Z, Shang M, Cai Y, Ge J, Min X, Wu X, Zhao S, Chen B. Ultrasound-guided percutaneous microwave ablation of gallbladder polyps: A case report. Medicine (Baltimore) 2023; 102:e36622. [PMID: 38134113 PMCID: PMC10735141 DOI: 10.1097/md.0000000000036622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE Gallbladder polyps are a general term for localized lesions in which the gallbladder wall protrudes into the gallbladder cavity, and benign lesions are common. Although current guidelines recommend cholecystectomy for gallbladder polyps ≥ 10 mm in size, the probability of finding cancer in postoperative pathological specimens is low. We should avoid unnecessary cholecystectomy and treat polyps with gallbladder preservation. Microwave ablation is safe and effective for the treatment of solid lesions, and can inactivates polyps while preserving gallbladder. Hence, we report a case of ultrasound-guided percutaneous microwave ablation of gallbladder polyps. PATIENT CONCERNS A 72-year-old female patient had previously diagnosed a gallbladder polyp, but it was not taken seriously. Recently, the patient had occasional right upper abdominal discomfort and a desire to preserve gallbladder. DIAGNOSES Ultrasound showed a medium hyperechoic papillary protrusion in the gallbladder without echo behind, and the changed position did not move. Contrast-enhanced ultrasound (CEUS) showed no malignant signs. The diagnosis was a gallbladder polyp. INTERVENTIONS The bile is drained and the drainage tube is fixed under real-time ultrasound guidance, then the gallbladder cavity is flushed and filled. Saline was injected between the serous and mucosal layers of the gallbladder to form an "edema band" to protect the gallbladder wall. Then, ultrasound-guided biopsy of gallbladder polyps was performed and sent for histological examination. Finally, the microwave needle was inserted into the target area under real-time ultrasonic guidance, and ablation was performed for 3 minutes (20 W). Postoperative CEUS: No significant enhancement was observed in the lesion. OUTCOMES Within 6 months of follow-up, the patient's gallbladder systolic function was normal, and there was no discomfort and no recurrence. The lesion reduction rate reached 100% at 1 week after surgery. LESSONS Ultrasound guided percutaneous microwave ablation of gallbladder polyps not only preserves the gallbladder but also inactivates the polyps without affecting the systolic function of the gallbladder, which provides a new idea for the treatment of gallbladder polyps.
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Affiliation(s)
- Huajiao Zhao
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Yanwei Chen
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Zheng Zhang
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Mengyuan Shang
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Yun Cai
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Jingwen Ge
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Xin Min
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Xincai Wu
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Shuangshuang Zhao
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
| | - Baoding Chen
- Department of Ultrasound Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang City, China
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Singla R, Dutta U, Aggarwal N, Bhadada SK, Kochhar R, Dhaliwal LK. Vitamin-D Deficiency Is Associated with Gallbladder Stasis Among Pregnant Women. Dig Dis Sci 2015; 60:2793-9. [PMID: 25963323 DOI: 10.1007/s10620-015-3678-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/17/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pregnant women are at increased risk of gallbladder (GB) stasis, an important risk factor for gallstones (GS). In non-pregnant women, Vitamin-D deficiency (VDD) is associated with GB stasis, which improves on supplementation. Relationship of VDD with GB stasis among pregnant women is not known. METHODS This is a prospective study in tertiary care centre. Consecutive healthy pregnant women (12-16 weeks gestation) were enrolled. Serum 25(OH) vitamin-D was estimated, and levels <20 ng ml(-1) were considered as VDD. Risk factors and clinical features of VDD were assessed. Gallbladder ejection fraction (GBEF) was assessed by ultrasound after a standard fatty meal, and <40 % was defined as stasis. Statistical analysis was performed to assess relationship of GB stasis and vitamin-D levels and identify factors associated with VDD. KEY RESULTS Median serum vitamin-D in 304 women was 7.9 ng ml(-1) (IQR 5.7, 12). VDD afflicted 92 % of them. Women with VDD more often had GB stasis (20 % vs 0 %; p = 0.015) and had lower GBEF [53.7 ± 17 % vs 59 ± 10 %; p = 0.026] compared to those with normal vitamin-D. GBEF showed positive correlation with vitamin-D levels (r = 0.117; p = 0.042). Risk factors for low vitamin-D levels were urban residence (p = 0.001), lower sun-exposure time (p = 0.005), limited skin exposure (p < 0.001), higher BMI (p = 0.05) and higher socioeconomic status (p = 0.02). Vitamin-D deficiency was associated with low serum calcium (ρ = 0.457; p < 0.001). CONCLUSIONS Vitamin D deficiency is highly prevalent among pregnant Indian women. It is associated with GB stasis and lower GBEF. The risk factors for VDD were reduced sun exposure, inadequate dietary intake and urban lifestyle.
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Affiliation(s)
- Rimpi Singla
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Goussous N, Kowdley GC, Sardana N, Spiegler E, Cunningham SC. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2015; 90:147-54. [PMID: 25278145 DOI: 10.1159/000365844] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Motility disorders of the biliary tree [biliary dyskinesia, including both gallbladder dysfunction (GBD), and sphincter of Oddi dysfunction] are difficult to diagnose and to treat. SUMMARY There is controversy in the literature in particular regarding the criteria that should be used to select patients for cholecystectomy (CCY) in cases of suspected GBD. The current review covers the history, diagnosis, and treatment of GBD. Key Messages: Only >85% of patients with suspected GBD have relief following CCY, a much lower rate than the nearly 100% success rate following CCY for gallstone disease. Unfortunately, the literature is lacking, and there are no universally agreed-upon criteria for selecting which patients to refer for operation, although cholecystokinin (CCK)-enhanced hepatobiliary iminodiacetic acid scan is often used, with emphasis on an abnormally low gallbladder ejection fraction or pain reproduction at CCK administration. There is a clear need for large, well-designed, more definitive, prospective studies to better identify the indications for and efficacy of CCY in cases of GBD.
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Affiliation(s)
- Naeem Goussous
- Department of Surgery, Saint Agnes Hospital, Baltimore, Md., USA
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Bielefeldt K, Saligram S, Zickmund SL, Dudekula A, Olyaee M, Yadav D. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59:2850-63. [PMID: 25193389 DOI: 10.1007/s10620-014-3342-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The focus of biliary dyskinesia (BD) shifted within the last 30 years, moving from symptoms after cholecystectomy (CCY) to symptoms with morphological normal gallbladder, but low gallbladder ejection fraction. METHODS We searched the pubmed database to systematically review studies focusing on the diagnosis and treatment of gallbladder dysfunction. RESULTS Impaired gallbladder contraction can be found in about 20% of healthy controls and an even higher number of patients with various other disorders. Surgery for BD increased after introduction of laparoscopic CCY, with BD now accounting for >20% of CCY in adults and up to 60% in pediatric patients. The majority of cases reported were operated in the USA, which differs from surgical series for cholelithiasis. Postoperative outcomes do not differ between groups with abnormal or normal gallbladder function. CONCLUSION Functional gallbladder testing should not be seen as an indicator of relevant biliary tract disease or prognostic marker to identify patients who may benefit from operative intervention. Instead biliary dyskinesia should be considered as a part of a spectrum of functional disorders, which are generally managed conservatively. Small proof of concept studies have demonstrated effects of medical therapy on biliary dysfunction and should thus be never tested in appropriately designed trials.
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Affiliation(s)
- Klaus Bielefeldt
- Divisions of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA,
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Lee JK, Kim Y, Lee S, Park JE. Hepatobiliary phase of gadoxetic acid-enhanced MR in patients suspected of having gallbladder dyskinesia: comparison with hepatobiliary scintigraphy. Clin Imaging 2014; 39:66-71. [PMID: 25457533 DOI: 10.1016/j.clinimag.2014.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/06/2014] [Accepted: 08/29/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (HMR) and hepatobiliary scintigraphy (HBS) for evaluation of cystic duct patency and gallbladder contractility in patients suspected of having gallbladder dyskinesia. MATERIALS AND METHODS Eighteen patients underwent HMR and HBS. Cystic duct patency and gallbladder ejection fraction (GBEF) were compared to determine a significant difference between HMR and HBS. RESULTS HMR and HBS had 15 concordant and 3 discordant results for cystic duct patency. GBEF in eight patients showed no significant difference between both modalities. CONCLUSION HMR may be an alternative to HBS for the functional evaluation of cystic duct patency and GBEF.
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Affiliation(s)
- Jeong Kyong Lee
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea.
| | - Yookyung Kim
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Sangmin Lee
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Ji Eun Park
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
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Cusack LK, Fernandez ML, Volek JS. The food matrix and sterol characteristics affect the plasma cholesterol lowering of phytosterol/phytostanol. Adv Nutr 2013; 4:633-43. [PMID: 24228192 PMCID: PMC3823509 DOI: 10.3945/an.113.004507] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Foods with added phytosterols/phytostanols (PS) are recommended to lower LDL cholesterol (LDL-c) concentrations. Manufacturers have incorporated PS into a variety of common foods. Understanding the cholesterol-lowering impact of the food matrix and the PS characteristics would maximize their success and increase the benefit to consumers. This review systematically examines whether the PS characteristics and the fatty acid composition of foods with added PS affects serum LDL-c. A total of 33 studies published between the years 1998 and 2011 inclusive of 66 individual primary variables (strata) were evaluated. The functional food matrices included margarine, mayonnaise, yogurt, milk, cheese, meat, grain, juice, and chocolate. Consistently, ≥10% reductions in LDL-c were reported when the characteristics of the food matrix included poly- and monounsaturated fatty acids known to lower LDL-c. Also, >10% mean reductions in LDL-c were reported when β-sitostanol and campestanol as well as stanol esters were used. These characteristics allow both low-fat and high-fat foods to successfully incorporate PS and significantly lower LDL-c.
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Affiliation(s)
| | | | - Jeff S. Volek
- Departments of Kinesiology and,To whom correspondence should be addressed. E-mail:
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Gonoi W, Akahane M, Watanabe Y, Isono S, Maeda E, Hagiwara K, Ohtomo K. Visualization of Bile Movement Using MRI Spin-Labeling Technique: Preliminary Results. AJR Am J Roentgenol 2013; 201:133-141. [PMID: 23789667 DOI: 10.2214/ajr.12.8928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masaaki Akahane
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasushi Watanabe
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Sachiko Isono
- MRI Applications, Toshiba Medical Systems, Tochigi, Japan
| | - Eriko Maeda
- Department of Computational Diagnostic Radiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuchika Hagiwara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Tsukagoshi T, Ohno K, Tsukamoto A, Fukushima K, Takahashi M, Nakashima K, Fujino Y, Tsujimoto H. Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele. Vet Radiol Ultrasound 2012; 53:84-91. [PMID: 22093059 DOI: 10.1111/j.1740-8261.2011.01868.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Biliary sludge in dogs is dismissed commonly as an incidental finding. On the other hand, gallbladder mucocele is reported increasingly in dogs and can lead to biliary obstruction or gallbladder rupture. Cholestasis is suspected to play a role in development of sludge and mucoceles, though there are no data in dogs to support this. We investigated gallbladder emptying, a key factor in biliary flow, in dogs with mobile sludge, immobile sludge, or gallbladder mucocele and in healthy controls. Gallbladder ejection fraction estimated by ultrasonography was used as the index of gallbladder emptying. The ejection fraction at 60 min after eating was significantly decreased in all three abnormal groups. Moreover, all dogs with sludge or a mucocele had gallbladder distension. These changes were the greatest in the mucocele group. Thus, biliary stasis occurs not only in dogs with gallbladder mucocele but also in dogs with biliary sludge. Cholestasis may play a role in the pathogenesis or progression of these diseases in dogs.
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Affiliation(s)
- Taro Tsukagoshi
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo Japan
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Hokama A, Kishimoto K, Ihama Y, Chinen H, Kinjo F, Fujita J. Gallbladder dysfunction diagnosed by cholescintigraphy with a Fatty meal. Gut Liver 2011; 4:556-7. [PMID: 21253309 DOI: 10.5009/gnl.2010.4.4.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 07/06/2010] [Indexed: 11/04/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
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