The natural history and significance of ultrasonographically defined polypoid lesions of the gallbladder in children

Diagnosis and treatment of gallbladder polypoid lesions: Current practices and future prospects

ABSTRACT

Gallbladder polypoid lesions (GPLs) refer to any elevated lesion of the mucosal surface of the gallbladder wall, and the prevalence is estimated to be between 0.9% and 12.1%. GPLs include benign polyps and malignant polyps. Benign polyps are further classified as non-neoplastic polyps and neoplastic polyps. Cholesterol polyps are the most common benign polyps and adenocarcinoma is the main type of malignant polyp. Hepatitis B virus infection, liver function abnormalities, dyslipidemia, and obesity are the main risk factors for GPLs. Studies of biological mechanisms have focused on malignant gallbladder polyps, the development of which is regulated by hormone levels in vivo , gut microbiota, inflammation, oxidative stress, Salmonella typhimurium , and related molecules. Diagnostic modalities include chemical examination and imaging examination, with imaging examination currently being the mainstay. Treatment of patients with GPLs is based on the presence or absence of symptoms, age, size of the polyps, tendency of the polyp to increase, and risk factors for symptomatic malignancy to determine whether surgery should be performed.

Gallbladder polyps and adenomyomatosis

Incidental findings are commonly detected during examination of the gallbladder. Differentiating benign from malignant lesions is critical because of the poor prognosis associated with gallbladder malignancy. Therefore, it is important that radiologists and sonographers are aware of common incidental gallbladder findings, which undoubtedly will continue to increase with growing medical imaging use. Ultrasound is the primary imaging modality used to examine the gallbladder and biliary tree, but contrast-enhanced ultrasound and MRI are increasingly used. This review article focuses on two common incidental findings in the gallbladder; adenomyomatosis and gallbladder polyps. The imaging features of these conditions will be reviewed and compared between radiological modalities, and the pathology, epidemiology, natural history, and management will be discussed.

Gallbladder polyp in children - a rare finding during ultrasound examination

Gallbladder polyps are a relatively rare finding in children. The increased use of high-resolution ultrasound in childhood allows to detect gallbladder lesions in young patients. A precise diagnosis can be established using different imaging series. Abdominal contrast-enhanced ultrasound examination provides the most accurate imaging information about the nature and size of the lesion. This is important for further decisions regarding patient referral for cholecystectomy. The object of this study was to present a case of gallbladder polyp diagnosed and followed up by contrast-enhanced ultrasound.

Gallbladder Polyps: Rare Lesions in Childhood

OBJECTIVE

Unlike adults, gallbladder polyps (GPs) are rare in childhood. The aim of this study was to evaluate patients with a GP diagnosis.

METHODS

Patients who were diagnosed with GP via ultrasonography from October 2012 to October 2017 were retrospectively evaluated in terms of sociodemographic characteristics and laboratory findings.

RESULTS

The study included 19 patients diagnosed with GP and followed up in our department. The patients comprised 14 (73.6%) girls with a mean age of 13.9 ± 4.1 years and a mean follow-up period of 10.2 ± 5.4 months (range, 3-26 months). The most common presenting symptom of the patients (n = 15, 78.9%) for ultrasonography was abdominal pain without biliary symptoms. Location of the polyps was in the corpus in 55% of patients, and either in the fundus (20%) or the neck of the gallbladder (25%). The average diameter of the polyps was 4.5 ± 1.6 mm (range, 2-9 mm). Multiple polyps were observed in 3 patients. No significant change in the number or size of polyps was noted at the end of the follow-up periods. Cholecystectomy was applied to 1 patient who had >5 polyps with a rapid increase in size, and the pathology report was hamartomatous polyp. There was no remarkable change in the clinical or laboratory findings of other patients during the follow-up period.

CONCLUSION

In this study, GPs could be seen in young children as young as 16 months of age and ultrasonography is sufficient for follow-up in stable and asymptomatic patients.

Is 14 the new 40: trends in gallstone disease and cholecystectomy in Australian children

BACKGROUNDS

Gallstone disease and cholecystectomy have been uncommon in paediatric patients and associated with haemolytic disease and prematurity. Many countries have observed an increase in the prevalence of paediatric gallstones and cholecystectomy with increasing childhood obesity. The purpose of this study was to determine any trend in prevalence in Australian children and the role of obesity.

METHODS

Chart review was conducted for patients undergoing cholecystectomy under 18 in 25 years between 1992 and 2016. Patients were grouped based on year of operation into five groups of 5 years each. Patient demographics including age and gender were noted, as were weight, height, and percentiles. Also noted were comorbidities, indication for surgery, whether elective or emergent, and procedure performed. Statistical analysis was performed using logistic regression on R-Studio^®.

RESULTS

Seventy-nine patients were included, 9, 15, 18, 18, and 19 in Groups 1-5, respectively. A trend was noted of increasing frequency which did not reach statistical significance. Nineteen patients had alternative explanations for gallstone disease, decreasing over time, coefficient - 10.5. A trend was also noted of increasing proportion of patients in higher percentiles for weight, which was statistically significant for those above the 98th percentile.

CONCLUSIONS

The changing profile of paediatric cholecystectomy is a little recognised aspect of the 'obesity epidemic'. This has implications when considering the impact of childhood overweight and obesity, and for clinicians involved in the diagnosis and management of these children.

Gallbladder polyp: A rare lesion in pediatric population

An 11-years-old girl with a polyp in the gallbladder is reported. Laparoscopic cholecystectomy was curative.