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Wang K, Xu Q, Xia L, Sun J, Shen K, Liu H, Xu L, Li R. Gallbladder polypoid lesions: Current practices and future prospects. Chin Med J (Engl) 2024; 137:1674-1683. [PMID: 38420780 PMCID: PMC11268823 DOI: 10.1097/cm9.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 03/02/2024] Open
Abstract
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.
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Affiliation(s)
- Kun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Qingpeng Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Lu Xia
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Jianing Sun
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Linning Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
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Liu H, Lu Y, Shen K, Zhou M, Mao X, Li R. Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures. BMC Gastroenterol 2024; 24:7. [PMID: 38166603 PMCID: PMC10759486 DOI: 10.1186/s12876-023-03094-7] [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: 05/24/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Gallbladder polyps are a common biliary tract disease whose treatment options have yet to be fully established. The indication of "polyps ≥ 10 mm in diameter" for cholecystectomy increases the possibility of gallbladder excision due to benign polyps. Compared to enumeration of risk factors in clinical guidelines, predictive models based on statistical methods and artificial intelligence provide a more intuitive representation of the malignancy degree of gallbladder polyps. Minimally invasive gallbladder-preserving polypectomy procedures, as a combination of checking and therapeutic approaches that allow for eradication of lesions and preservation of a functional gallbladder at the same time, have been shown to maximize the benefits to patients with benign polyps. Despite the reported good outcomes of predictive models and gallbladder-preserving polypectomy procedures, the studies were associated with various limitations, including small sample sizes, insufficient data types, and unknown long-term efficacy, thereby enhancing the need for multicenter and large-scale clinical studies. In conclusion, the emergence of predictive models and minimally invasive gallbladder-preserving polypectomy procedures has signaled an ever increasing attention to the role of the gallbladder and clinical management of gallbladder polyps.
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Affiliation(s)
- Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Yongda Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Ming Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Xiaozhe Mao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China.
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Shang L, Shen X, Niu W, Zhang Y, Han J, Liu H, Liu L, Chen X, Zhang Y, Hai S. Update on the natural orifice transluminal endoscopic surgery for gallbladder preserving gallstones therapy: A review. Medicine (Baltimore) 2022; 101:e31810. [PMID: 36401453 PMCID: PMC9678607 DOI: 10.1097/md.0000000000031810] [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] [Indexed: 12/03/2022] Open
Abstract
Cholecystectomy remains the "gold standard" for the management of symptomatic gallstones. Minimally invasive laparoscopic cholecystectomy has been the treatment of choice for the past 3 decades. However, the technique of natural orifice transluminal endoscopic surgery cholecystolithotomy is evolving, with some experts advocating gallbladder stone removal without gallbladder excision in order to preserve gallbladder function and eliminate post-cholecystectomy syndromes, including complications of the surgical incision, bile duct injury, functional gastrointestinal, and psychological conditions, and possibly an increase in colon cancer. In addition, transluminal endoscopic cholecystolithotomy is an option for elderly patients who are not suitable candidates for open surgery and those who desire scar-free minimally invasive surgery with organ preservation. This article summarizes the established pure natural orifice transluminal endoscopic surgery gallbladder preserving gallstone removal techniques and highlights the pros and cons of different popular available endoscopic approaches to gallstone therapy and how flexible endoscopic surgery via the natural orifice is compared to the well-established cholecystectomy.
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Affiliation(s)
- Lifeng Shang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Xin Shen
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Wenkai Niu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Yi Zhang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Junwei Han
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Haiwang Liu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Lei Liu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Xinli Chen
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Yiyue Zhang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Shi Hai
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
- *Correspondence: Shi Hai, Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an 710000, P.R. China (e-mail: )
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Guo XW, Liang YX, Huang PY, Liang LX, Zeng YQ, Ding Z. Snare-assisted flexible endoscope in trans-gastric endoscopic gallbladder-preserving surgery: A pilot animal study. World J Gastroenterol 2022; 28:2112-2122. [PMID: 35664034 PMCID: PMC9134132 DOI: 10.3748/wjg.v28.i19.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/23/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving surgery by flexible endoscopy is an emerging technology. However, the gallbladder fails to obtain traction and positioning functions during the operation.
AIM To evaluate the feasibility and safety of a new surgical method, “snare-assisted pure NOTES gallbladder-preserving surgery”.
METHODS Eight miniature pigs were randomly divided into the experimental group [NOTES gallbladder-preserving surgery using the snare device, snare assisted (SA)] and the control group (NOTES gallbladder-preserving surgery without using the snare device, NC), with four cases in each group. The differences between the two groups of animals in operating time, operating workload, complications, adverse events, white blood cells, and liver function were determined.
RESULTS No differences were found in the surgical success rate, gallbladder incision closure, white blood cell count, or liver function between the two groups. The total operating time, gallbladder incision blood loss, gallbladder disorientation time, gallbladder incision closure time, and workload scores on the National Aeronautics and Space Administration-Task Load Index were significantly reduced in the SA group (P < 0.05).
CONCLUSION These results indicated that snare-assisted pure NOTES gallbladder-preservation surgery using standard endoscopic instruments reduced the difficulty of operation, shortened operation time, and did not increase complications in pigs. A new method for pure NOTES gallbladder-preservation surgery was provided.
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Affiliation(s)
- Xian-Wen Guo
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
- Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yun-Xiao Liang
- Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Peng-Yu Huang
- Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Lie-Xin Liang
- Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Qing Zeng
- Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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