Can gallbladder polyps predict colorectal adenoma or even neoplasia? A systematic review

Predicting colorectal adenomatous polyps in patients with chronic liver disease: A novel nomogram

BACKGROUND

Colorectal polyps are commonly observed in patients with chronic liver disease (CLD) and pose a significant clinical concern because of their potential for malignancy.

AIM

To explore the clinical characteristics of colorectal polyps in patients with CLD, a nomogram was established to predict the presence of adenomatous polyps (AP).

METHODS

Patients with CLD who underwent colonoscopy at Tianjin Second People's Hospital from January 2020 to May 2023 were evaluated. Clinical data including laboratory results, colonoscopy findings, and pathology reports were collected. Key variables for the nomogram were identified through least absolute shrinkage and selection operator regression, followed by multivariate logistic regression. The performance of the model was evaluated using the area under the receiver area under curve, as well as calibration curves and decision curve analysis.

RESULTS

The study enrolled 870 participants who underwent colonoscopy, and the detection rate of AP in patients with CLD was 28.6%. Compared to individuals without polyps, six risk factors were identified as predictors for AP occurrence: Age, male sex, body mass index, alcohol consumption, overlapping metabolic dysfunction-associated steatotic liver disease, and serum ferritin levels. The novel nomogram (AP model) demonstrated an area under curve of 0.801 (95% confidence interval: 0.756-0.845) and 0.785 (95% confidence interval: 0.712-0.858) in the training and validation groups. Calibration curves indicated good agreement among predicted and actual probabilities (training: χ 2 = 11.860, P = 0.157; validation: χ 2 = 7.055, P = 0.530). The decision curve analysis underscored the clinical utility of the nomogram for predicting the risk of AP.

CONCLUSION

The AP model showed reasonable accuracy and provided a clinical foundation for predicting the occurrence of AP in patients with CLD, which has a certain predictive value.

Should Gallbladder Pathologies Be Investigated in Patients With Colon Polyps?

Background Data regarding the frequency of development of gallbladder pathologies in patients with colon polyps are quite limited and heterogeneous. Hence, this study aimed to investigate whether colon polyps cause an increased risk of developing gallbladder pathologies and the necessity of ultrasonographic screening. Methodology This retrospective, cross-sectional study was conducted among adult patients who underwent a colonoscopy and hepatobiliary ultrasound as part of their health check-up from January 2018 to January 2023. The frequency, etiological factors, and association of gallbladder pathologies with colon polyps were investigated. Results A total of 128 patients were included in the study. When the distribution of colon polyp pathology was examined, 78.9% (n = 101) were adenomas, 18.8% (n = 24) were non-neoplastic polyps, and 2.3% (n = 3) were adenocarcinomas. The rate of patients with gallbladder stones was 10.9% (n = 14) and the rate of patients with polyps was 18.8% (n = 24). On multivariate logistic regression analysis, variables found to be significant for the development of gallbladder pathologies were determined as obesity, hyperlipidemia, and polyp's distal colon location. Conclusions Obesity and metabolic syndrome were among the etiological factors in this patient group. Hepatobiliary ultrasound, a non-invasive and inexpensive examination, is useful in patients with colon polyps.

A Noninvasive Risk Stratification Tool Build Using an Artificial Intelligence Approach for Colorectal Polyps Based on Annual Checkup Data

Colorectal cancer is the leading cause of cancer-related deaths worldwide, and early detection has proven to be an effective method for reducing mortality. The machine learning method can be implemented to build a noninvasive stratifying tool that helps identify patients with potential colorectal precancerous lesions (polyps). This study aimed to develop a noninvasive risk-stratified tool for colorectal polyps in asymptomatic, healthy participants. A total of 20,129 consecutive asymptomatic patients who underwent a health checkup between January 2005 and August 2007 were recruited. Positive relationships between noninvasive risk factors, such as age, Helicobacter pylori infection, hypertension, gallbladder polyps/stone, and BMI and colorectal polyps were observed (p < 0.0001), regardless of sex, whereas significant findings were noted in men with tooth disease (p = 0.0053). A risk stratification tool was developed, for colorectal polyps, that considers annual checkup results from noninvasive examinations. For the noninvasive stratified tool, the area under the receiver operating characteristic curve (AUC) of obese females (males) aged <50 years was 91% (83%). In elderly patients (>50 years old), the AUCs of the stratifying tools were >85%. Our results indicate that the risk stratification tool can be built by using random forest and serve as an efficient noninvasive tool to identify patients requiring colonoscopy.

Unusual Case of Gallbladder Adenocarcinoma Metastasis to the Abdominal Wall 11 Years Later: Synchronous Presentation with Two Malignant Colon Tumors, Coincidence or Not?

Introduction

Abdominal wall masses are a common finding in clinical practice. A high percentage of these masses are malignant. We present the case of a patient operated for a gallbladder adenocarcinoma, who consulted eleven years later for a malignant mass of the abdominal wall in synchrony with two adenocarcinomas of the left colon and sigmoid. Case Report. A 75-year-old male underwent a laparoscopic cholecystectomy with an incidental diagnosis of adenocarcinoma in situ (TisN0M0 according to AJCC 8th edition). The operative report mentioned that the removal of the gallbladder was difficult due to the inflammatory process, and the gallbladder was accidentally opened during the operation. It was not clear from the operative report whether an extraction bag was utilized to remove the specimen, but the histopathological study confirmed an open gallbladder. He presented 11 years later with an asymptomatic heterogeneous complex cystic mass involving the anterior rectus abdominis muscle. Colonoscopy showed synchronous tumors in the descending and sigmoid colon with pathology confirming adenocarcinoma. The patient underwent an elective laparotomy with resection of the anterior abdominal wall mass, left hemicolectomy, and sigmoidectomy. The histopathological results of the abdominal mass (CK7, CK20, EMA, CEA positive) were described as metastasis of adenocarcinoma of biliary origin. Discussion. Port site recurrences are rare complications following laparoscopic surgery when malignancy is unsuspected. Possible factors related to local implantation include direct seeding of spilled bile or tumor cells into the wound or shedding of tumor cells due to pneumoperitoneum-induced loss of the peritoneal barrier at the trocar site. In the absence of distant metastasis, treatment should include wide port site excision with malignancy-free surgical margins.

Conclusion

Abdominal wall metastasis from gallbladder carcinoma is rare, and its synchronous presentation with a malignant neoplasm of the colon is exceptional. This is the first report of a patient with abdominal wall metastasis from a gallbladder adenocarcinoma operated eleven years ago that debuted synchronously with two adenocarcinomas of the left colon and sigma.

Gallbladder Polyps Are Associated with Proximal Colon Polyps

Background

The association between gallbladder (GB) disease and colorectal precancerous lesions remains elusive. This study sought to explore the association between GB disease and colorectal neoplasms at different locations.

Methods

Patients who received general health checkup from January to December 2008 were included and subgrouped into three groups by polyp location: proximal, distal, and whole colon. GB disease and other known risk factors for colon cancer were compared and analyzed. Different types of polyps at different locations were further investigated.

Results

Of a total of 3136 patients (1776 men and 1360 women; mean age, 49.3 years) who had colon polyps, 212 (6.8%) had GB stone and 512 (16.3%) had GB polyps. Patients in the proximal colon polyp group had higher rates of GB polyps and stones. GB polyps were independently associated with proximal colon polyps, including both hyperplastic polyps (odds ratio, 1.523; P = 0.034) and adenomatous polyps (odds ratio, 1.351; P = 0.048). No relationship between GB polyps and distal or any colon polyps was observed. Irrespective of the polyp location (i.e., proximal, distal, or any part of the colon), GB stone did not show any association with colon polyp.

Conclusions

We suggested that GB polyps are associated with proximal colon polyps. Colonoscopy may be a more effective strategy for screening proximal precancerous lesions among patients with GB polyps. The association between GB disease and colon polyps demands further prospective investigation.

Gallbladder stones and gallbladder polyps associated with increased risk of colorectal adenoma in men

BACKGROUND AND AIMS

Most cases of colorectal cancer develop via an adenoma to carcinoma sequence. Gallbladder polyps share some risk factors with colorectal polyps. Little is known about the relationship between gallbladder diseases and different status of colorectal polyps by gender. This study was to investigate the association of gallbladder stones and polyps with colorectal adenomas by gender in a Taiwanese population.

METHODS

A total of 7066 eligible subjects who underwent a total colonoscopy as a part of health check-up between January 2001 and August 2009 were recruited. Colonoscopic findings were classified into polyp-free, non-neoplastic polyps and colorectal adenomas. Gallbladder stones and gallbladder polyps were diagnosed based on ultrasonographic findings.

RESULTS

There was a significant difference in the status of colon polyps between subjects with and without gallbladder polyps. However, the status of colon polyps was not significantly different between subjects with or without gallbladder stones. After adjusting obesity, fasting plasma glucose, and other variables, there was a positive relationship between gallbladder polyps and colorectal adenomas (odds ratio [OR]: 1.396, 95% confidence interval [CI]: 1.115-1.747) but not non-neoplastic polyps in all subjects. In men, gallbladder polyps (OR: 1.560, 95% CI: 1.204-2.019) and gallbladder stones (OR: 1.465, 95% CI 1.081-1.984) were positively associated with colorectal adenomas. In women, neither gallbladder polyps nor gallbladder stones were significantly related to colon polyps.

CONCLUSIONS

Both gallbladder polyps and gallbladder stones were associated with an increased risk of colorectal adenomas in men but not in women. Gender difference was significant for the association between gallbladder lesions and colorectal polyps.