Shifting prevalence of gallbladder polyps in Korea

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.

Association between nonalcoholic fatty liver disease and gallstone risk in nonobese and lean individuals

PURPOSE

The association between nonobese/lean nonalcoholic fatty liver disease (NAFLD) and gallstone formation remains unclear. We aimed to assess whether NAFLD is an independent risk factor for gallstones, even in nonobese or lean individuals.

METHODS

We analyzed 265 353 asymptomatic adults who underwent abdominal ultrasonography. The risk of gallstone was assessed on the basis of obesity and NAFLD status.

RESULTS

The overall prevalence rates of NAFLD and gallstones were 27.1% and 2.6%, respectively. The prevalence rates of NAFLD among the 195 204 nonobese and 136 194 lean participants were 14.7% and 7.4%, respectively. Individuals with NAFLD had a significantly increased risk of gallstones (adjusted odds ratio [OR], 1.23; 95% confidence interval [CI], 1.14-1.32). Moreover, NAFLD significantly increased the risk of gallstone (adjusted OR, 1.29; 95% CI, 1.17-1.41) among nonobese individuals. Lean individuals with NAFLD also exhibited a significantly increased risk of gallstones (adjusted OR, 1.20; 95% CI, 1.03-1.40). Furthermore, these findings remained consistent even in nonobese and lean individuals without insulin resistance.

CONCLUSION

Nonobese/lean NAFLD is an independent risk factor for gallstone formation, suggesting its role in gallstone pathogenesis, regardless of obesity status. Therefore, when hepatic steatosis is detected on abdominal ultrasonography, a more thorough evaluation of the gallstones may be necessary, even in nonobese or lean individuals.

Retrospective Study of the Prevalence and Associated Factors of Gallbladder Polyps among Residents of Two Korean Cities

Background/Aims: Well-known risk factors for gallbladder polyps include metabolic syndrome, age, and dyslipidemia. Jeju Island is approximately 80 km from the Korean peninsula and is divided into two administrative regions (Jeju City and Seogwipo City), with Mount Halla intervening in the center. Jeju City has higher employment and birth rates than Seogwipo City. Age and alcohol consumption differ between the two regions, and these factors may affect the prevalence of gallbladder polyps (GBPs). Therefore, we investigated the prevalence of GBPs and compared various factors, including alcohol consumption habits and age, associated with GBPs among residents in the two regions. Methods: This study included 21,734 residents who visited the Health Screening and Promotion Center of Jeju National University Hospital between January 2009 and December 2019. We investigated the prevalence and associated factors of GBPs among residents of Jeju City and Seogwipo City. Results: The prevalence of GBPs in Jeju City and Seogwipo City was 9.8% and 8.9% (p = 0.043), respectively. The mean age and rate of high-risk alcohol intake were higher in Seogwipo City. The mean body mass index and levels of fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, aspartate aminotransferase, gamma-glutamyl transferase, and alkaline phosphatase were lower in Jeju City. Conclusions: This study demonstrated a significant difference in GBP prevalence between the two regions of Jeju Island. Age and alcohol consumption might contribute to this difference; however, further prospective cohort studies are warranted to confirm our findings.

Impact of nonalcoholic fatty liver disease on the risk of gallbladder polyps in lean and non-obese individuals: A cohort study

BACKGROUND

The association between non-obese or lean nonalcoholic fatty liver disease (NAFLD) and gallbladder polyps (GBPs) has not yet been evaluated. We aimed to determine whether NAFLD is an independent risk factor for the development of GBPs, even in non-obese and lean individuals.

METHODS

We analyzed a cohort of 331 208 asymptomatic adults who underwent abdominal ultrasonography (US). The risk of GBP development was evaluated according to the obesity and NAFLD status.

RESULTS

The overall prevalence of NAFLD and GBPs ≥ 5 mm was 28.5% and 2.9%, respectively. The prevalence of NAFLD among 160 276 lean, 77 676 overweight and 93 256 obese participants was 8.2%, 31.2%, and 61.1%, respectively. Individuals with NAFLD had a significantly higher incidence of GBPs with a size of ≥ 5 mm [adjusted odds ratio (OR) = 1.18; 95% confidence interval (CI): 1.11-1.25]. A higher body mass index and its categories were also significantly associated with an increased risk of GBPs ≥ 5 mm. Moreover, risk of GBPs ≥ 5 mm was significantly increased even in NAFLD individuals who are not obese (lean: adjusted OR = 1.36, 95% CI: 1.19-1.54; overweight: adjusted OR = 1.14, 95% CI: 1.03-1.26, respectively).

CONCLUSIONS

Non-obese/lean NAFLD is an independent risk factor for GBP development, suggesting that NAFLD may play an important role in the pathogenesis of GBPs regardless of the obesity status. Therefore, a more thorough evaluation for GBPs may be necessary when hepatic steatosis is detected on abdominal US, even in non-obese or lean individuals.

Impact of hepatitis B virus infection on the risk of gallbladder polyps: a cohort study

BACKGROUND/AIMS

We aimed to determine whether hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains an important risk factor for gallbladder polyps (GBPs) in the current context of reduced prevalence of these infections.

METHODS

The cohort included 392,913 asymptomatic adults who underwent abdominal ultrasonography (US).

RESULTS

The prevalence of GBP sized ≥ 5 mm, ≥ 10 mm, and overall (< 5, 5-9 and ≥ 10 mm) was 2.9%, 0.1%, and 12.8%, respectively. The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and hepatitis C antibody (anti-HCV) positivity was 3.2%, 26.7%, and 0.1%, respectively. The GBP risk was significantly increased in HBsAg-positive individuals, with an adjusted odds ratio of 1.66 (95% confidence interval, 1.49-1.85) for GBP ≥ 5 mm, 2.39 (1.53-3.75) for GBP ≥ 10 mm, and 1.49 (1.41-1.59) for overall, whereas there was no significant association between anti-HCV positivity and GBP risk. The GBP risk did not increase significantly in individuals who tested negative for HBsAg but positive for HBcAb.

CONCLUSION

The presence of HBsAg may be an independent risk factor for GBP development in the current context of a indecreasing prevalence of HBsAg positivity. A more comprehensive evaluation of GBP during abdominal US surveillance of HBsAg-positive individuals may be necessary.

Differences in the Impact of Obesity and Metabolic Unhealthiness on the Risk of Gallbladder Polyp

PURPOSE

Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status.

MATERIALS AND METHODS

A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO).

RESULTS

The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04-1.19], 1.30 (95% CI, 1.15-1.47), and 1.37 (95% CI, 1.28-1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group.

CONCLUSION

Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.

A Bayesian network model to predict neoplastic risk for patients with gallbladder polyps larger than 10 mm based on preoperative ultrasound features

BACKGROUND

Polyp size of 10 mm is insufficient to discriminate neoplastic and non-neoplastic risk in patients with gallbladder polyps (GPs). The aim of the study is to develop a Bayesian network (BN) prediction model to identify neoplastic polyps and create more precise criteria for surgical indications in patients with GPs lager than 10 mm based on preoperative ultrasound features.

METHODS

A BN prediction model was established and validated based on the independent risk variables using data from 759 patients with GPs who underwent cholecystectomy from January 2015 to August 2022 at 11 tertiary hospitals in China. The area under receiver operating characteristic curves (AUCs) were used to evaluate the predictive ability of the BN model and current guidelines, and Delong test was used to compare the AUCs.

RESULTS

The mean values of polyp cross-sectional area (CSA), long, and short diameter of neoplastic polyps were higher than those of non-neoplastic polyps (P < 0.0001). Independent neoplastic risk factors for GPs included single polyp, polyp CSA ≥ 85 mm ², fundus with broad base, and medium echogenicity. The accuracy of the BN model established based on the above independent variables was 81.88% and 82.35% in the training and testing sets, respectively. Delong test also showed that the AUCs of the BN model was better than that of JSHBPS, ESGAR, US-reported, and CCBS in training and testing sets, respectively (P < 0.05).

CONCLUSION

A Bayesian network model was accurate and practical for predicting neoplastic risk in patients with gallbladder polyps larger than 10 mm based on preoperative ultrasound features.

Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper

The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.

The Diagnostic Yield of Abdominal Ultrasounds Requested by Family Physicians at an Academic Hospital in Riyadh, Saudi Arabia

Background: Abdominal ultrasound is a non-invasive, relatively inexpensive, and widely available diagnostic modality in family medicine settings.

Objectives: Our study aimed to identify the most common indications for requesting abdominal ultrasounds by family physicians, determine the frequency of abdominal ultrasound with abnormal findings, identify the most common findings, and determine patients’ characteristics associated with abnormal findings.

Methods: This retrospective chart-based study was conducted from January 2020 to June 2020 to analyze patients’ abdominal ultrasounds reports requested by family physicians in 2019 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.

Results: We assessed abdominal ultrasound reports of 1,113 patients. There were 620 (55.7%) female patients. The mean age and body mass index (BMI) were 46.35 years ± 15.04 and 29.33 kg/m² ± 7.06, respectively. The most common indications were abdominal pain (43.2%), suspicion of gallbladder and biliary system diseases (18.5%), and abnormal liver function tests (14.6%). The frequency of abnormal findings was 793 (71.2%), and the most common findings were fatty liver infiltration (49.7%), liver enlargement (20.1%), and gallstones (13.3%). Females had a lower likelihood to have abnormal findings compared to males (odds ratio (OR)=0.688, p=0.009). Lastly, the likelihood of abnormal findings increased with age and was highest among patients aged 71 years or more (OR=25.9, p< 0.001).

Conclusion: Abnormal findings were more prevalent in our study compared with other studies. Abnormal findings were more common among males and older age groups. We recommend future studies on patients from community-based family medicine settings, and to examine the association of abnormal findings with patient-centered endpoints. Finally, disseminating the results of this study will inform family physicians with the most common abnormal abdominal ultrasound findings, and will enhance the discussion with patients undergoing an abdominal ultrasound examination.

Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study

Purpose

The incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea.

Methods

The National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends.

Results

The ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017.

Conclusion

This study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.

Prevalence and risk factors of gallbladder polyps in primary health care centers among patients examined by abdominal ultrasonography in Qatar: a case-control study

BACKGROUND

Gallbladder (GB) polyps are raised lesions from the GB wall and projected into its lumen. The prevalence of GB polyps ranged between 4.3% and 12.3%. The clinical presentation of GB polypoid lesions vary, can be nonspecific and vague, and may be asymptomatic. Identifying malignant and premalignant polyps is important to provide treatment early and prevent cancer spread or development of malignancy. Ultrasonography (US) is the first imaging modality widely used in abdominal imaging. It is a noninvasive, rapid, painless, and safe imaging technique, with no radiation; thus, it is considered the best available examination with good sensitivity and specificity for GB polyps.

AIM OF THE WORK

This study aimed to determine the relative frequency of the GB polyps and its risk factors among patients who underwent abdominal US in Primary Health Care Corporation, Qatar.

MATERIALS AND METHODS

This was quantitative multicenter observational case-control study nested in a cross-sectional design. For the cross-sectional top-level study, the first step was to assess available abdominal ultrasound studies for the presence of GB polyps and stones. The second step was to perform a case-control study with three groups (a case group and two control groups; first, participants without GB stones and GB polyps; second, patients with GB stones but without GB polyps).

RESULTS

The study evaluated the GB images of 7156 individuals. The overall prevalence of GB polyps was 7.4% in the study population. Specifically, the overall prevalence of solitary GB polyp was 4.2% and that of multiple GB polyps was 3.2%. Regarding the size distribution of GB polyps in positive cases, 89.4% were < 6 mm, 9.3% were 69 mm, and 1.3% were ≥ 10 mm. Prevalence rate of selected comorbidities were as follows: liver disease, 1.8%; diabetes mellitus, 25.5%; hypertension, 25.5%; and dyslipidemia, 29.8%. The prevalence in male and female patients was 7.7% and 7%, respectively. The prevalence of GB polyps was higher in south-eastern patients (21.4% of positive cases) and was the highest in the overweight group (8.8%). A higher prevalence was noted in the hypertensive group (hypertensive group, 9.8%; non-hypertensive group, 6.6%) and dyslipidemia group (dyslipidemia group, 7.8%; no dyslipidemia group, 7.2%). Moreover, a higher prevalence was noted in hepatitis B surface (HBS)-positive group (15%) than in the HBS-negative group (8.2%) and slightly higher in Helicobacter pylori antigen positive group than in the negative group.

CONCLUSION

Abdominal US is an important and commonly used imaging modality in the detection of GB polyps. In this study, the prevalence of GB polyps was approximately 7.4%, with higher prevalence in participants who were overweight and had diabetes mellitus, hypertension, and dyslipidemia.

Are there modifiable risk factors affecting the prevalence of gallbladder polyps or those 5 mm or larger? A retrospective cross-sectional study

Gallbladder polyps (GBPs), especially GBPs ≥5 mm in diameter, are clinically important because they can progress to gallbladder cancer. The known modifiable risk factors for GBP are obesity, metabolic syndrome, and dyslipidemia; however, there is limited evidence regarding specific modifiable risk factors for GBPs ≥5 mm in diameter. Therefore, this study is aimed to investigate the existence of modifiable risk factors affecting the prevalence of GBPs and GBPs ≥5 mm in diameter in a Korean population.A total of 10,119 subjects who visited a single health-screening center at Jeju National University Hospital between January 2009 and December 2019 was included in this study. Binary logistic analyses were performed to identify risk factors affecting the prevalence of GBPs and GBPs ≥5 mm in diameter.The overall prevalence of GBPs and GBPs ≥5 mm in diameter were 9.0% and 4.1%, respectively. Multivariable analysis identified male gender as an independent risk factor affecting the prevalence of GBPs. Moreover, multivariable analysis revealed age and high-density lipoprotein cholesterol levels as independent risk factors for GBPs ≥5 mm in diameter.This study showed that gender was a risk factor affecting the prevalence of GBPs and that age and high-density lipoprotein-cholesterol levels were risk factors for the presence of GBPs ≥5 mm in diameter. High-density lipoprotein cholesterol levels could be a modifiable risk factor affecting the prevalence of large-diameter GBPs.

Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion

OBJECTIVES

To compare the diagnostic value of high frame rate contrast-enhanced ultrasound (H-CEUS) in distinguishing gallbladder adenomas from cholesterol polyp lesions with that of CEUS.

METHODS

This study enrolled 94 patients with gallbladder polyp lesions (GPLs) who underwent laparoscopic cholecystectomy. CEUS and H-CEUS were performed before surgery. The perfusion features of GPLs and the final diagnosis as determined by both technologies were compared.

RESULTS

There were differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on H-CEUS (p < 0.05), while there were no differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on CEUS (p > 0.05). In the cholesterol polyp lesion group, there were no differences in vascular types between CEUS and H-CEUS (p > 0.05), while the vascular types were different between CEUS and H-CEUS in the gallbladder adenoma group (p < 0.05). The diagnostic value of H-CEUS in distinguishing gallbladder adenomas from cholesterol polyp lesions was better than that of CEUS.

CONCLUSIONS

H-CEUS improved the time resolution by increasing the frame rate, which helped to accurately reflect the difference in the microcirculation of GPLs and improved the ability of a differential diagnosis between cholesterol polyp lesions and adenomas. H-CUES may provide an effective means of imaging for patients with GPLs regarding the choice of treatment options.

KEY POINTS

• High frame rate CEUS improves the time resolution of CEUS by increasing the frame rate. • High frame rate CEUS is helpful to accurately evaluate the microvascular morphology of a gallbladder polyp lesion in the arterial phase. • High frame rate CEUS helps patients with gallbladder polyp lesions to choose the appropriate treatment means.

Analysis of risk factors for gallbladder polyp formation - A retrospective study based on serial ultrasounds

AIM

To evaluate gallbladder polyp (GBP) formation related risk factors based on serial ultrasounds (US).

METHODS

Risk factors related GBP formation were retrospectively investigated among participants, who had US reexamination and interval >180 days in 5 years. After groups were divided based on US, we compared final data and initial data in GBP new incidence group. Then compared the data in GBP new incidence group and GBP(-) group.

RESULTS

Overall 20 447 participants were recruited, including 18 243 in GBP (-) group and 2204 in GBP group. The mean diameters of polyps were 0.455 ± 0.198 mm in initial and 0.420 ± 0.180 mm in final examination. GBP new incidence group included 797 participants. Percentage of GBP new incidence participants was higher than GBP resolved (36.16% vs. 11.71%). Participants in middle age were more likely have GBP size increase or new incidence, and participants in old age (≥60 years old) were with GBP size decrease or resolved. In GBP new incidence group, participants in final US showed higher FBG, higher LDL, lower HDL, higher ALT and higher AST than initial US. Compared with GBP (-) group and, same risk factors, in addition with age, were shown in GBP new incidence group, Logistic regression analysis show that higher LDL, lower HDL and higher AST were risk factors for GBP formation.

CONCLUSION

Participants in middle age were more likely to have GBP new incidence. Higher LDL, lower HDL and higher AST were independently risk factors for GBP formation.

Association between the non-HDL-cholesterol-to-HDL-cholesterol ratio and the risk of gallbladder polyp formation among men: a retrospective cohort study

Background

Dyslipidaemia and male sex are associated with gallbladder polyp (GBP) formation. However, the potential relation between the non-high-density lipoprotein-cholesterol-to-high-density lipoprotein-cholesterol (non-HDL-c/HDL-c) ratio and GBPs in men is unclear.

Methods

A total of 1866 eligible subjects were selected for this retrospective cohort study from Wuhan Union Hospital between April 1, 2013, and November 30, 2014. Clinical and laboratory data of subjects were collected. Patients with GBPs or cholecystectomy at baseline, with missing data for baseline lipid profiles, following abdominal ultrasonography or taking lipid-lowering drugs were excluded. The patients were divided into five groups based on their non-HDL-c/HDL-c ratios, and descriptive analyses of the baseline data were performed. A Cox proportional hazards model was applied to estimate the relationship between the non-HDL-c/HDL-c ratio and GBPs.

Results

After a median follow-up of 1 year, 7.34% (n = 137) of the subjects developed GBPs. Compared with subjects without GBPs, those who developed GBPs after follow-up had significantly higher triglyceride (TG) levels and non-HDL-c/HDL-c ratios. The prevalence of GBPs showed a linearity increment with age, peaked in the 30–39 years group, 40–49 years group and 50–59 years group, and then declined slightly. The results of univariate analysis showed that the non-HDL-c/HDL-c ratio (hazard ratio (HR) = 1.29, 95% confidence interval (CI), 1.05–1.60, P = 0.0159) was positively correlated with GBPs. In the fully adjusted Cox regression model, the HRs were 2.24 for quintile 2 (95% CI: 1.13–4.44, P = 0.0203), 1.50 for quintile 3 (95% CI: 0.73–3.10, P = 0.269), 2.52 for quintile 4 (95% CI: 1.26–5.01, P = 0.0087) and 2.13 for quintile 5 (95% CI: 1.04–4.37, P = 0.0397). No interaction was found among the subgroups.

Conclusions

A higher non-HDL-c/HDL-c ratio is independently related to a higher risk of GBP formation in Chinese men. Further research is needed to investigate whether this association exists in different regions and races.

Risk factors of gallbladder polyps formation in East Asian population: A meta-analysis and systematic review

To perform Meta-analysis to identify risk factors associated with gallbladder polyps (GBP) formation in east Asian population. Three English electronic bibliographic databases includes PubMed, Embase and Medline, with reviewed researches from 1986 to 2017. All possible risk factors of GBP formation were recorded. Meta-analyses were performed by Review Manager Software. Pooled odds ratios (OR) or the mean difference (MD) were used to determine risk factors. Sixteen studies and 227021 people were recruited, including 17261 people with GBP and 209760 without GBP. For categorical variables evaluated by OR test., risk factors of GBP formation were male gender (OR, 1.63; 95%CI, 1.42-1.87) and positive HBsAg. GBP formation were not correlated with age <50 years old, hypertension, DM, BMI ≥ 25kg/m², smoking, drinking, HDL decrease, TC increase, TG increase, fatty liver and GBS. For continuous variables evaluated by MD test, risk factors of GBP formation were DBP (MD, 1.08; 95%CI, 0.15-2.02), mean BMI (MD,0.19; 95%CI,0.02-0.35), waist circumference (MD,1.780; 95%CI, 0.17,3.40), mean LDL (MD,0.89; 95%CI,0.03-1.75), mean HDL (MD,-1.87; 95%CI,-3.21 to -0.52). GBP formation were not correlated with mean age, SBP, mean TC, mean TG, ASL and ALT. In conclusion, risk factors of gallbladder polyp formation included male gender, higher BMI, higher waist circumference, higher DBP, higher LDL, lower HDL and positive HBsAg in east Asian population. GBP formation was not correlated with age, hypertension, DM, smoking, drinking, fatty liver, GBS, TC, TG, SBP, ASL and ALT. The mechanism of Dyslipidemias causing GBP needs deeper study in future.

Correlation of dyslipidemias and gallbladder polyps-A large retrospective study among Chinese population

OBJECTIVE

Aim to explore the association of dyslipidemias with GBP prevalence, number and size in a large Chinese population in Beijing. Dyslipidemias include hypercholesterolemia, hypertriglyceridemia, increased low density lipoprotein (LDL) and decreased high density lipoproteins (HDL).

METHODS

Prevalence of GBP and its association with dyslipidemias were retrospectively investigated among subjects who underwent check-up at Health Screening Center of Xuanwu Hospital between January 2014 and December 2017.

RESULTS

This study enrolled 97117 participants. Prevalence of GBP was 7.3%. There were significant differences in increased LDL (595/7107 vs 6004/90010, P = 0.000) and increased cholesterol (TC) (403/7107 vs 4846/90010,P = 0.000) between GBP group and control group, but not in decreased HDL and increased triglyceride (TG). Logistic regression analysis showed that gender, age, BMI, SBP, DBP and LDL were independently associated with GBP. People with increases LDL had 1.488 times higher risk for GBP formation. Trend of dyslipidemias prevalence change according to age was similar with that of GBP. Increased LDL group had higher GBP prevalence rate (9.0% vs 7.2%, p = 0.000), multiple GBP proportion (2.9% vs 2.2%, p = 0.000) and large polyps with diameter ≥ 5 mm proportion (3.7% vs 2.6%,p = 0.000). Comparing with control group, there was higher proportion of large polyps in Increased TC group (3.2% vs 2.7%, p = 0.019) and decreased HDL group (3.0% vs 2.6%,p = 0.028). Increased TG group had not difference with its control group in GBP prevalence, number or size.

CONCLUSION

Dyslipidemias is associated with GBP formation. Dyslipidemias change according to age is consistent with GBP prevalence. Increased LDL was a more related risk factor rather than decreased HDL, increased TC or TG.

Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives

INTRODUCTION

Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development.

MATERIALS AND METHODS

GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0-27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps.

RESULTS

Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas.

CONCLUSION

Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3-12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy.

HOW TO CITE THIS ARTICLE

Dilek ON, Karsu S, et al. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019;9(1):40-48.

Strategy for discriminating cholesterol and premalignancy in polypoid lesions of the gallbladder: a single-centre, retrospective cohort study

BACKGROUND

The present study aimed to assess the risk factors of cholesterol and premalignancy in polypoid lesions of the gallbladder (PLGs) and to establish an appropriate treatment strategy.

METHODS

Data from patients who underwent cholecystectomy at the First Affiliated Hospital, School of Medicine, Zhejiang University, between January 2011 and July 2017, were collected retrospectively.

RESULTS

A total of 1561 patients were included in the present study. The cohort comprised of 636 (40.7%) males and 925 (59.3%) females, with a mean age of 49.5 (range 16-88) years; 65.6% (1024/1561) demonstrated cholesterol lesions in this cohort, among which cholesterol polyps accounted for 81.0%. Age younger than 50 years and multiple number of polyps were found to be independent predictive variables for cholesterol lesions (odds ratio (OR) 3.461, 95% confidence interval (CI) 2.058-5.820, P < 0.001 and OR 3.321, 95% CI 1.988-5.547, P < 0.001, respectively). The presence of polyp growth was associated with premalignancy (OR 5.366, 95% CI 1.466-19.637, P = 0.011), and the presence of clinical symptoms indicated benign non-cholesterol lesions (OR 0.368, 95% CI 0.153-0.885, P = 0.026).

CONCLUSION

In the case of patients ≥50 years old with single asymptomatic polyp, cholecystectomy was recommended if the polyp presented growth at a rate above 3-4 mm within 6 months. If not, trimonthly ultrasound follow up was recommended, and clinicians should carefully assess the risk factors for premalignancy in PLGs.

Metabolic status and lifestyle factors associated with gallbladder polyps: a covariance structure analysis

Background

Gallbladder Polyps (GBP) are highly prevalent in China; however, the etiology of GBP has not been clearly defined. This study explored the associations between lifestyle factors and GBP and whether it mediated by metabolic factors or not.

Methods

A total of 487 newly diagnosed GBP cases and 502 healthy controls were involved in this study. A questionnaire was used to investigate the socio-demographic characteristics and lifestyle factors. Food Intake Frequencies Questionnaire was used to obtain the food intake frequencies of seven food categories. Blood was tested for lipid profiles, fasting blood glucose and blood urine acid. A Covariance Structure Analysis was used in the analysis to explore the possible pathways between socio-demographic characteristics, lifestyle factors, metabolic factor and GBP.

Results

The Covariance Structure Analysis showed that a higher BMI and elevated triglyceride level mediated the association between age and GBP. Lifestyle factors (smoking and drinking) and higher intake frequencies of fatty food (meat and viscera) also linked to higher BMI and higher triglyceride level, respectively, which were associated with GBP.

Conclusion

In conclusion, age and lifestyle factors might be indirectly related with GBP through BMI and the triglyceride pathway.

Predictive Model for Neoplastic Potential of Gallbladder Polyp

GOAL

To provide the statistical predictive model for neoplastic potential of gallbladder polyp (GBP).

BACKGROUND

Many studies have attempted to define the risk factors for neoplastic potential of GBP. It remains difficult to precisely adapt the reported risk factors for the decision of surgery. Estimating the probability for neoplastic potential of GBP using a combination of several risk factors before surgical resection would be useful in patient consultation.

STUDY

We collected data of patients confirmed as GBP through cholecystectomy at Samsung Medical Center between January 1997 and March 2015. Those with a definite evidence for malignancy, such as adjacent organ invasion, metastasis on preoperative imaging studies, polyp >15 mm, and absence of proper preoperative ultrasonographic imaging were excluded. A total of 1976 patients were enrolled. To make and validate the predictive model, we divided the cohort into the modeling group (n=979) and validation group (n=997). Clinical information, ultrasonographic findings, and blood tests were retrospectively analyzed.

RESULTS

Clinical factors of older age, single lesion, sessile shape, and polyp size showed statistical significance for neoplastic potential of GBP in the modeling group. A predictive model for neoplastic potential of GBP was constructed utilizing the statistical outcome of the modeling group. Statistical validation was performed with the validation group to determine the optimal clinical sensitivity and specificity of the predictive model. Optimal cut-off value for neoplastic probability was 7.4%.

CONCLUSIONS

The predictive model for neoplastic potential of GBP may support clinical decisions before cholecystectomy.

The gallbladder polypoid-lesions conundrum: moving forward with controversy by looking back

Gallbladder polypoid-lesions (GPs) are found in 5-10% of the general population. Although the majority of GPs are asymptomatic and benign in nature, some of them can develop into cancer, which carries a poor prognosis. Currently, the risk factors, natural history and classification of GPs remain unclear, differentiation of benign from malignant or premalignant GPs based on available diagnostic modalities and/or features of patients and GPs remain difficult, and there are still no evidence-based guidelines to dictate when and how GPs of varying sizes and subtypes should be managed. All of these facts have left GPs in uncertainty. Areas covered: A literature search was performed using the terms 'gallbladder polyps' AND 'polypoid lesion of gallbladder' in the PubMed database from January 2000 to September 2016. Original and review articles on almost all aspects of GPs in humans, especially diagnosis, treatment and surveillance, were reviewed and analyzed. Reference lists of reviews and original articles were also examined for relevant publications. Expert commentary: The present article summarizes almost all aspects of GPs, analyzes the controversies, and outlines our data and comments. It is the authors' purpose that this article be beneficial for scientific, accurate and appropriate management of GPs.

Gallstone, cholecystectomy and risk of gastric cancer

Backgrounds/Aims

The aim of this retrospective study is to compare stomach cancer incidence, characteristics between gallstones, cholecystectomy and control groups. It also aims to investigate key variables' potential effects on overall survival.

Methods

A total of 99 patients, diagnosed with stomach cancers between April 1994 and December 2015, were identified. We excluded stomach cancer patients, accrued during the first year of follow-up in both the gallstones and cholecystectomy groups, assuming that they missed cancers. The main analyses addressing the objective were a chi-square analysis and a survival analysis.

Results

The incidence of stomach cancers was increased in both the gallstone and cholecystectomy groups, compared with the control group (p=0.003). Multivariate regression analysis showed that the overall survival in gallstones, cholecystectomy group patients as compared with those in the control group decreased (HR=6.66, 95 CI: 1.94–22.80, p=0.003). Also, T-stage was found to statistically affect the rate of overall survival (HR=9.85, 95% CI: 3.09–31.39, p=.000). The stomach cancer showed the worse survival at the posterior, greater curvature location than anterior, lesser curvature of the stomach. (HR=0.30, 95% CI: 0.11–0.80, p=0.017).

Conclusions

We provided an awareness of the possible increased risks of stomach cancer in gallstone and cholecystectomy group patients, which might be induced by duodenogastric bile reflux. Also, the survival rate was poor (p<0.000). Therefore, close follow-up strategies for early detection are recommended for such patients.

Prevalence and Risk Factors of Gallbladder Polypoid Lesions in a Healthy Population

PURPOSE

To determine the prevalence of and investigate the risk factors for gallbladder (GB) polypoid lesions in a healthy population.

MATERIALS AND METHODS

A total of 23827 subjects who underwent abdominal ultrasonography in conjunction with health screening examinations were retrospectively analyzed. The prevalence of risk factors for GB polypoid lesions were evaluated. In addition, risk factors according to the number of polypoid lesions and the presence of stones with polypoid lesions were investigated. To analyze these risk factors, a control group was established with a 1:2 ratio matched for age and sex.

RESULTS

The prevalence of GB polypoid lesions was identified as 9.96%. On multivariate analysis, chronic hepatitis B infection (CHB) and the presence of metabolic syndrome (MS) were risk factors for GB polypoid lesions. CHB and MS were also significant independent risk factors for multiple GB polypoid lesions when compared with solitary GB polypoid lesions. In addition, gastric Helicobacter pylori infection and MS were significant risk factors for GB polypoid lesions with stones when compared with GB polypoid lesions without stones.

CONCLUSION

The prevalence of GB polypoid lesions in a healthy Korean population was 9.96%. Patients with CHB and MS need to be carefully examined for such lesions.

Determinants for gallstone formation - a new data cohort study and a systematic review with meta-analysis

OBJECTIVE

Only few determinants of gallstone formation have been identified in cohort studies. The aim was to identify further determinants for gallstones in a Danish cohort and to perform a meta-analysis of results from existing cohorts.

MATERIAL AND METHODS

Data from a cohort study was used. Gallstone incidence was assessed through repeated ultrasound examinations. Body mass index (BMI), blood pressure, self-rated health, lifestyle variables, blood lipids, and use of female sex hormones were measured at the baseline examination. Statistical analyses included logistic regression. Based on a prospective protocol, a systematic review of the literature was performed identifying all articles dealing with determinants of incident gallstones. Meta-analyses of comparable determinants were performed through fixed effect models.

RESULTS

Participants with no gallstones at baseline and with at least one re-examination were followed-up completely (mean 11.6 years, N = 2848). The overall cumulative incidence of gallstones was 0.60% per year. Independent positive determinants for incident gallstones were age, female sex, non-high density lipoprotein (non-HDL) cholesterol, and gallbladder polyps. In addition, BMI was positively associated in men. The systematic review additionally identified associations for comorbidities, parity, and dietary factors. Meta-analysis confirmed the significant associations for incident gallstones and age, female sex, BMI, and non-HDL cholesterol. No significant associations were found for blood pressure, smoking, alcohol consumption, HDL cholesterol, or triglycerides in meta-analyses.

CONCLUSIONS

Age, female sex, BMI, non-HDL cholesterol, and polyps are independent determinants for gallstone formation. Incident gallstones and the metabolic syndrome share common risk factors. More studies are needed for further exploration.

The Risk of Colorectal Neoplasia in Patients with Gallbladder Diseases

Cholecystectomy is associated with an increased risk of colorectal cancer, but little is known about the relationship between gallbladder disease and colorectal adenoma. Gallbladder polyps and colorectal neoplasia (CRN) share several risk factors such as obesity, diabetes and metabolic syndrome, which might account for their association. In this study, we investigated whether asymptomatic patients with gallbladder disease are at increased risk of CRN and identified the factors to their association. The study population consisted of 4,626 consecutive, asymptomatic individuals drawn from a prospective health check-up cohort who underwent both ultrasonography and colonoscopy screening. The prevalence of CRNs in patients with gallbladder polyps or gallstones was significantly higher than that in the control group (32.1% vs. 26.8%; P = 0.032, 35.8% vs. 26.9%; P = 0.020). A multivariate regression analysis showed that gallbladder polyps were an independent risk factor for CRN [adjusted odds ratio (OR): 1.29; 95% confidence interval (CI); 1.03-1.62] whereas gallstones were not (adjusted OR: 1.14; 95% CI: 0.79-1.63). The adjusted OR for the risk of CRN was 1.12 for gallbladder polyps < 5 mm (95% CI, 0.85-1.46) and 1.79 for gallbladder polyps ≥ 5 mm (95% CI, 1.15-2.77). The prevalence of CRN increased with increasing polyp size (P trend = 0.022). Our results suggest that colorectal neoplasia is significantly related to gallbladder polyps, especially those ≥ 5 mm.