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Bridges KM, Diaz FJ, Wang Z, Ahmed I, Sullivan DK, Umar S, Buckles DC, Greiner KA, Hester CM. Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population. Genes (Basel) 2018; 9:genes9030119. [PMID: 29495356 PMCID: PMC5867840 DOI: 10.3390/genes9030119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the United States, yet it is treatable and preventable. African Americans have higher incidence of CRC than other racial/ethnic groups, however, it is unclear whether this disparity is primarily due to environmental or biological factors. Short chain fatty acids (SCFAs) are metabolites produced by bacteria in the colon and are known to be inversely related to CRC progression. The aim of this study is to investigate how stool SCFA levels, markers of inflammation in stool and dietary intake relate to colonoscopy findings in a diverse patient population. Stool samples from forty-eight participants were analyzed for SCFA levels and inflammatory markers (lysozyme, secretory IgA, lactoferrin). Additionally, participants completed the National Cancer Institute's Diet History Questionnaire II (DHQ II) to report dietary intake over the past year. Subsequently, the majority of participants underwent screening colonoscopy. Our results showed that African Americans had higher total levels of SCFAs in stool than other racial/ethnic groups, significantly lower intake of non-starchy vegetables and similar inflammatory marker expression and colonoscopy outcomes, compared to others. This work is an initial exploration into the biological and clinical factors that may ultimately inform personalized screening approaches and clinical decision-making to improve colorectal cancer disparities for African Americans.
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Affiliation(s)
- Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Francisco J Diaz
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Zhiwen Wang
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Ishfaq Ahmed
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Shahid Umar
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Daniel C Buckles
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - K Allen Greiner
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Christina M Hester
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
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Brown J, Alsop B, Gupta N, Buckles DC, Olyaee MS, Vennalaganti P, Kanakadandi VN, Saligram S, Sharma P. Effectiveness of focal vs. balloon radiofrequency ablation devices in the treatment of Barrett's esophagus. United European Gastroenterol J 2015; 4:236-41. [PMID: 27087952 DOI: 10.1177/2050640615594549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS The safety and efficacy of radiofrequency ablation (RFA) in treatment of Barrett's esophagus (BE)-associated dysplasia has been well established. The effectiveness of focal and balloon RFA devices has not been compared. Therefore, the aim of our study was to assess the effectiveness of focal and balloon RFA devices in the treatment of BE by calculating absolute and percentage change in BE length with RFA therapy by comparing pre- and post-treatment BE length. PATIENTS AND METHODS This is a retrospective cross-sectional study of patients who underwent at least one treatment with either focal and/or balloon RFA devices who were identified from two tertiary centers. Patients' demographics, hiatal hernia, pre- and post-treatment BE length, prior use of endoscopic therapies and number of sessions were recorded. RESULTS Sixty-one patients who had undergone 161 RFA treatment sessions met inclusion criteria. There was no significant difference in percentage change in BE length with greater number of RFA sessions. RFA with a focal device resulted in greater percentage reduction in BE length compared to the balloon system (73% vs. 39%, p < 0.01). After adjusting for initial BE length, pre-treatment BE length, hernia status, prior endoscopic mucosal resection (EMR), prior RFA, and prior EMR/RFA sessions, RFA with a focal device at each session remained an independent predictor for a significant reduction in BE extent as compared to the balloon system. CONCLUSION The focal RFA device alone was more effective in treatment of BE compared to the balloon system, with a greater reduction in extent of BE. The focal RFA device for endoscopic eradication therapy of BE should be considered the preferred technique.
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Affiliation(s)
- Jesica Brown
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, USA; Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | - Benjamin Alsop
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, USA; Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | - Neil Gupta
- Gastroenterology, Loyola University, USA
| | - Daniel C Buckles
- Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | - Mojtaba S Olyaee
- Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | | | - Vijay Naag Kanakadandi
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, USA; Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | - Shreyas Saligram
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, USA; Gastroenterology and Hepatology, University of Kansas Medical Center, USA
| | - Prateek Sharma
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, USA; Gastroenterology and Hepatology, University of Kansas Medical Center, USA
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Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
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Rastogi A, Rao DS, Gupta N, Grisolano SW, Buckles DC, Sidorenko E, Bonino J, Matsuda T, Dekker E, Kaltenbach T, Singh R, Wani S, Sharma P, Olyaee MS, Bansal A, East JE. Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study. Gastrointest Endosc 2014; 79:390-8. [PMID: 24021492 DOI: 10.1016/j.gie.2013.07.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 07/17/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Experts can accurately characterize the histology of diminutive polyps with narrow-band imaging (NBI). There are limited data on the performance of non-experts. OBJECTIVE To assess the impact of a computer-based teaching module on the accuracy of predicting polyp histology with NBI by non-experts (in academics and community practice) by using video clips. DESIGN Prospective, observational study. SETTING Academic and community practice. PARTICIPANTS A total of 15 gastroenterologists participated-5 experts in NBI, 5 non-experts in academic practice, and 5 non-experts in community practice. INTERVENTION Participants reviewed a 20-minute, computer-based teaching module outlining the different NBI features for hyperplastic and adenomatous polyps. MAIN OUTCOME MEASUREMENTS Performance characteristics in characterizing the histology of diminutive polyps with NBI by using short video clips before (pretest) and after (posttest) reviewing the teaching module. RESULTS Non-experts in academic practice showed a significant improvement in the sensitivity (54% vs 79%; P < .001), accuracy (64% vs 81%; P < .001), and proportion of high-confidence diagnoses (49% vs 69%; P < .001) in the posttest. Non-experts in community practice had significantly higher sensitivity (58% vs 75%; P = .004), specificity (76% vs 90%; P = .04), accuracy (64% vs 81%; P < .001), and proportion of high-confidence diagnoses (49% vs 72%; P < .001) in the posttest. Performance of experts in NBI was significantly better than non-experts in both academic and community practice. LIMITATIONS Selection bias in selecting good quality videos. Performance not assessed during live colonoscopy. CONCLUSION Academic and community gastroenterologists without prior experience in NBI can achieve significant improvements in characterizing diminutive polyp histology after a brief computer-based training. The durability of these results and applicability in everyday practice are uncertain.
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Affiliation(s)
- Amit Rastogi
- Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, United States; Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Deepthi S Rao
- Department of Pathology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Neil Gupta
- Department of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Scott W Grisolano
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Daniel C Buckles
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Elena Sidorenko
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - John Bonino
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Takahisa Matsuda
- Department of Gastroenterology, National Cancer Center Hospital, Tokyo, Japan
| | - Evelien Dekker
- Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Tonya Kaltenbach
- Department of Gastroenterology, Veterans Affairs Medical Center Palo Alto, Stanford University School of Medicine, Palo Alto, California, United States
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Sachin Wani
- Department of Gastroenterology, University of Colorado, Denver, Colorado, United States
| | - Prateek Sharma
- Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, United States; Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Mojtaba S Olyaee
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Ajay Bansal
- Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, United States; Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - James E East
- Department of Gastroenterology, John Radcliffe Hospital, Oxford, United Kingdom
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Gupta N, Nayak R, Grisolano SW, Buckles DC, Tadros PN. Defining patients at high risk for gastrointestinal hemorrhage after drug-eluting stent placement: a cost utility analysis. J Interv Cardiol 2010; 23:179-87. [PMID: 20236217 DOI: 10.1111/j.1540-8183.2010.00530.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The study goal was to evaluate the cost-effectiveness of drug-eluting stent (DES) placement with consideration of gastrointestinal (GI) bleeding risk. DES reduce the need for future coronary revascularization, but require prolonged dual anti-platelet (DAT) therapy, which may increase the risk for GI bleeding. While DES have been found to be cost-effective in patients at average risk for GI bleeding, they may not be the most cost-effective strategy in higher risk patients. METHODS A Markov model was created to compare DES with bare metal stents (BMS). Patients were a hypothetical cohort of 60-year-old individuals with coronary artery stenosis that required nonemergent percutaneous coronary revascularization (PCI). The primary outcomes were the threshold incremental risks of GI bleeding from DAT based on willingness to pay (WTP) of $50,000, $100,000, and $150,000 per quality adjusted life year (QALY) gained. RESULTS For a WTP of $100,000, the relative risk of GI bleeding from DAT could be as high as 10.8 (when compared to aspirin alone) before DES would no longer be cost-effective. In patients with two risk factors for GI bleeding, the threshold relative risk could be as low as 1.6. CONCLUSION In average-risk patients, the risk of GI bleeding from DAT can be substantial without affecting the cost-effectiveness of DES. However, DES are unlikely to be cost-effective in patients with two or more risk factors for GI bleeding.
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Affiliation(s)
- Neil Gupta
- Division of Gastroenterology/Hepatology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
Gastroparesis is a condition of impaired gastric motility that can be chronic and result in decreased quality of life and complete disability. Once the diagnosis of gastroparesis is established, the clinician's attention should immediately focus on restoring nutritional status, providing symptomatic relief from nausea and vomiting, and improving gastric motility. Combination therapy is the rule rather than the exception, and most patients require multiple prokinetic and antiemetic modalities for adequate symptom relief. Currently available medications are often inadequate to achieve therapeutic goals, and newer modalities, such as gastric electrical stimulation, which has been shown to decrease symptoms and improve quality of life, should be employed at a low threshold. Several novel therapeutic options are under investigation and may also become part of the routine treatment of gastroparesis.
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Affiliation(s)
- Daniel C. Buckles
- Division of Gastroenterology and Hepatology, Kansas University Medical Center, 4035 Delp, 3901 Rainbow Boulevard, Kansas City, KS 66205, USA.
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Buckles DC, Sarosiek I, McMillin C, McCallum RW. Delayed Gastric Emptying in Gastroesophageal Reflux Disease: Reassessment with New Methods and Symptomatic Correlations. Am J Med Sci 2004; 327:1-4. [PMID: 14722388 DOI: 10.1097/00000441-200401000-00001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have shown that patients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than control subjects, but the prevalence has differed because of variations in methodology. The recent establishment of international control values for scintigraphic gastric emptying assessment makes standardization of this technique possible. It would also be useful to determine whether specific gastrointestinal symptoms predicted delayed gastric emptying in GERD. METHODS Forty-nine patients (mean age, 42.9 years; range, 24-65 years; 35 women, 14 men) who were diagnosed with GERD in the previous 12 months were given a standardized 280-kcal 99Tc-labeled low fat meal (egg beater). Percentage of intragastric residual content was recorded at baseline and at hourly intervals for 240 minutes by scintigraphy. Patients were also asked about the presence of dyspepsia (bloating, postprandial discomfort or belching, or early satiety), dysphagia, or regurgitation. RESULTS Sixteen patients (33%) had intragastric residual contents greater than the 95th percentile (>40%) at 120 minutes, and 13 (26%) had abnormal results at 240 minutes (>6%). Dyspepsia was present in all patients. Regurgitation and dysphagia were common (present in approximately 80% and 40% of patients, respectively) and the prevalence of these symptoms did not differ between patients with normal versus delayed gastric emptying. CONCLUSIONS Using standardized techniques: 1) delayed gastric emptying is common in patients presenting with GERD at both 120 and 240 minutes after ingestion of a solid meal and 2) symptoms alone are not a useful predictor of this pathophysiology. Awareness of this subgroup of patients can be important in treatment strategies and long-term therapy.
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Affiliation(s)
- Daniel C Buckles
- Division of Gastroenterology and Hepatology, Department of Medicine, Kansas University Medical Center, Kansas City 66205, USA
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Buckles DC, Forster J, McCallum RW. The treatment of gastroparesis in the age of the gastric pacemaker: a review. MedGenMed 2003; 5:5. [PMID: 14745352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Gastroparesis is a chronic disabling condition of impaired gastric motility that results in decreased quality of life. Currently available medical therapy consists of prokinetic medication combined with antiemetic therapy, dietary modifications, and nutritional supplementation. Many patients continue to have a suboptimal clinical response despite maximal use of these modalities. Instead of surgery, which involves irreversible stomach-modifying procedures, gastric electrical stimulation (GES) with a high-frequency/low-energy stimulus was approved by the US Food and Drug Administration (FDA) and can now be used in this setting. This approach has been shown to decrease symptom frequency and severity, reduce hospitalizations and medical costs, and improve quality of life. Occurrence of complications with this device are uncommon (< 5% of patients). Preliminary studies of new gastric stimulators that restore gastric contractility are promising, but additional investigation is needed. This article reviews the pathophysiology and epidemiology of gastroparesis and the role of conventional medical therapies, and discusses GES therapy with respect to its mechanisms of action, appropriate application, results and benefits, and future directions.
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Affiliation(s)
- Daniel C Buckles
- Division of Gastroenterology and Hepatology, Department of Medicine, Kansas University Medical Center, Kansas City, USA
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Abstract
OBJECTIVE The management of gallbladder polyps/masses in patients with primary sclerosing cholangitis (PSC) (i.e., cholecystectomy vs observation) remains problematic. Given the risk of biliary tract cancer in PSC in the face of the benign nature of most gallbladder polyps in the general population, our aim was to determine the prevalence of gallbladder cancer in PSC patients with a gallbladder mass who had undergone cholecystectomy. METHODS The case records of all patients with PSC undergoing a cholecystectomy at the Mayo Clinic between 1977-1999 were reviewed. RESULTS Of the 102 patients with PSC who underwent a cholecystectomy, 14 of 102 (13.7%) had a gallbladder mass. In the subset of patients with gallbladder masses, eight of 14 (57%) had adenocarcinomas (seven primary adenocarcinomas and one metastatic cholangiocarcinoma); the other six had benign masses (five adenomas and one cholesterol polyp). In those patients with benign masses, 33% had associated epithelial cell dysplasia; in patients with primary gallbladder cancers, 57% had associated dysplasia. The patients with primary gallbladder adenocarcinoma had a favorable outcome after cholecystectomy, with a 36-month survival of 66%. CONCLUSIONS In conclusion, gallbladder neoplasms in PSC patients are malignant in approximately 40-60% of the cases. The presence of gallbladder epithelial cell dysplasia suggests a dysplasia-carcinoma sequence in PSC similar to that observed in ulcerative colitis. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder polyps. If a cholecystectomy is not performed, careful interval follow-up is warranted.
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Affiliation(s)
- Daniel C Buckles
- Division of Gastroenterology and Hepatology, Mayo Medical School, Clinic, and Foundation, Rochester, Minnesota 55905, USA
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