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Objective:To investigate the anxiety and depression in patients with gallbladder polyps, gallbladder stones and post-cholecystectomy.Methods:From December 2020 to August 2021, consecutive patients who visited the Department of Gastroenterology, First Affiliated Hospital of Air Force Medical University, were enrolled and divided into normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group, with 100 patients in each group. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate patients′ anxiety or depression. Quality of life, sleep quality and severity of gastrointestinal symptom were assessed by short form 36 (SF-36), Pittsburgh sleep quality index (PSQI) scale and gastrointestinal symptom rating scale (GSRS) respectively. The incidence of anxiety or depression of patients in the 4 groups were compared, and the related risk factors of anxiety and depression were analyzed. Chi-square test and multiple logistic regression were used for statistical analysis.Results:Among 400 patients, 89 patients (22.2%) suffered from anxiety; and the incidences of anxiety of normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were 9.0% (9/100), 19.0% (19/100), 25.0% (25/100) and 36.0% (36/100) respectively. There was statistically significant difference in the incidence of anxiety among the 4 groups ( χ2=22.12, P<0.001). The incidence rates of anxiety of the gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were all higher than that of the normal gallbladder group, and the differences were all statistically significant ( χ2=4.15, 9.07 and 20.90, P=0.042, 0.003 and <0.001). The incidence of anxiety of post-cholecystectomy group was higher than that of gallbladder polyp group, and the difference was statistically significant ( χ2=7.25, P=0.007). Among the 400 patients, 70 patients (17.5%) suffered from depression. The incidence rates of depression of the normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were 5.0% (5/100), 10.0% (10/100), 24.0% (24/100) and 31.0% (31/100) respectively. There was statistically significant difference in the incidence of depression among the 4 groups ( χ2=30.27, P<0.001). The incidences of depression of the gallbladder stone group and post-cholecystectomy group were both higher than that of the normal gallbladder group and gallbladder polyp group, and the differences were statistically significant ( χ2=14.56, 22.90, 6.94 and 13.53, P<0.001, <0.001, =0.008 and <0.001). The results of multivariate analysis showed that history of cholecystectomy, history of coronary heart disease, consumption of overnight food ≥3 times per week, PSQI score ≥ 8 and GSRS score ≥9 were independent risk factors for anxiety ( OR, 95%confidence interval: 4.02, 1.60 to 10.13; 10.01, 2.15 to 46.68; 4.15, 1.87 to 9.19; 4.69, 2.58 to 8.52; 3.02, 1.64 to 5.58; P=0.003, 0.003, <0.001, <0.001, and <0.001). Gallbladder stones history of cholecystectomy, consumption of overnight food ≥3 times per week, consumption of fresh fruit < 200 g/d, PSQI score ≥8 and GSRS score ≥9 were independent risk factors for depression ( OR, 95%confidence interval: 4.40, 1.38 to 14.06; 4.97, 1.54 to 16.12; 4.23, 1.61 to 11.08; 3.78, 1.32 to 10.85; 5.59, 2.78 to 11.27, 4.19, 1.94 to 9.04; P=0.012, 0.007, 0.003, 0.014, <0.001 and <0.001). Conclusions:The incidences of anxiety and depression in patients with gallbladder stones or post-cholecystectomy are higher than that of people with normal gallbladder. A history of cholecystectomy is the independent risk factor for anxiety and depression. Gallbladder stones is the independent risk factor of depression. Clinical attention should be paid to the mental state of patients with gallbladder polyps, gallbladder stones, especially post-cholecystectomy.
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Objective:To analyze the feasibility and efficacy of ultrasound-guided percutaneous biopsy and radiofrequency ablation of gallbladder polyps.Methods:From April 2019 to January 2021, 25 patients with gallbladder polyps underwent ultrasound-guided biopsy and radiofrequency ablation in the ultrasound department of the First Affiliated Hospital of Zhengzhou University were collected, the maximum diameter of the lesion was 11.00(10.00, 12.50)mm. Under general anesthesia, ultrasound-guided injection of water into the gallbladder serosa layer was performed to make the gallbladder edema thicker than or equal to 10 mm. Percutaneous biopsy and radiofrequency ablation of gallbladder polyps were performed to ablate the gallbladder mucosa layer of polyps and polyp attachment.Intraoperative contrast-enhanced ultrasound was used to evaluate the need for supplementary ablation.The operation time, intraoperative and postoperative conditions were recorded. The complete ablation rate of gallbladder polyps, the reduction rate of lesion volume after ablation, the incidence of complications and the effect of operation on gallbladder wall thickness and gallbladder contraction rate were evaluated.Results:Biopsy and radiofrequency ablation of gallbladder polyps were successfully performed in 25 patients.There were 14 cases of cholesterol polyp, 5 cases of adenoma, 5 cases of inflammatory polyp and 1 case of gallbladder adenomyosis. Twenty-nine gallbladder polyps showed changes after ablation, and the lesion volume was reduced to varying degrees. In the first, third and sixth months, the volume reduction rates of ablation focus were 70.74%(58.55%, 77.56%), 89.47%(85.04%, 96.87%) and 100%(95.68%, 100%) respectively, and the differences were statistically significant ( P<0.05). There were no significant differences in gallbladder wall thickness and gallbladder contraction rate before and 1 month after operation ( P>0.05). The operation time was 14-39(23.32±6.68)min. During the operation, 3 patients(12.0%) had a decrease in heart rate, 2 patients(8.0%) had mild abdominal pain and 1 patient(4.0%) had obvious abdominal pain, which was relieved after treatment. No bleeding, gallbladder perforation, abdominal infection and other complications occurred. All patients were followed up for 1 to 22 months, with a median of 6 (3, 7) months. No patients were lost or follow-up, polyp recurrence, or new polyps, or secondary gallstone. Conclusions:Ultrasound-guided biopsy and radiofrequency ablation of gallbladder polyps is a feasible choice for gallbladder preserving treatment of gallbladder polyps with low complication rate.
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Objective To study the relationship among bile components and different gallstone types through comparing and analyzing gallbladder bile contents in patients with different types of gallstones.Methods A retrospective study of 542 consecutive patients with gallstones or gallbladder polyps was conducted.The stone composition type and 14 kinds of bile components from these patients were analyzed.The bile parameters consisted of potassium (K +),sodium (Na+),chlorine (Cl-),calcium (Ca2+),bicarbonate (HCO3-),magnesium (Mg2+),aspartate aminotransferase (AST),glutamyltranspeptidase (GGT),alkaline phosphatase (ALP),total bilirubin (TBIL),total bile acid (TBA),cholesterol (CHO),lactate dehydrogenase (LDH) and pH.Finally,the content of these bile components among the different types of stones and gallbladder polyps were compared.According to the composition determined by Fourier transform infrared spectroscopy (FTIR),the gallstone patients were divided into five groups.Results Compared with other groups,the content of K +,GGT,ALP,TBIL,TBA and CHO in the calcium carbonate stone group were lower (P ＜ 0.05),while the levels of C1-,HCO3-and value of PH were higher (P ＜0.05).Furthermore,CHO content in the cholesterol stone group was higher than other groups (P ＜ 0.05)except for the gallbladder polyp group (P ＞ 0.05).In addition,there was no difference in bile contents among the pigment gallstone group,mixed stone group and polyp group (P ＞ 0.05).Conclusions In gallstone patients,the bile components of patients with calcium carbonate stones is significantly different.The high cholesterol content in bile is the main feature of cholesterol stone patients,and there is no significant difference in bile composition between patients with pigment stones and mixed stones.
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Gallbladder polyps is one of the most common diseases in the general surgery.How to get accurate preoperative diagnosis is of great significance for the choice of treatment options.This review summarizes the imaging methods commonly used in preoperative pathological diagnosis of gallbladder polyps,hoping to help clinicians in the development of treatment strategies for gallbladder polyps.
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Objective To investigate the risk factors of malignancy from gallbladder polyps (GBPs).Methods The retrospective case-control study was conducted.The clinicopathological data of 604 patients with GBPs who were admitted to the Chinese PLA General Hospital between January 2011 and October 2016 were collected.There were 255 males and 349 females,aged from 19 to 88 years,with an average age of 47 years.There were 565 of 604 patients with benign GBPs and 39 with malignant GBPs.Observation indicators:(1) risk factors analysis of malignancy from GBPs;(2) the predictive ability of polyp diameter for malignancy from GBPs.Measurement data with normal distribution were expressed as Mean ± SD,measurement data with skewed distribution were described as M (range),and the univariate analysis was done using the t test or rank-sum test.Count data were described by the absolute amount,and the univariate analysis was done using the chi-square test or Fisher exact probability.The indicators with P＜0.05 in the univariate analysis based on clinical application were used in the Logistic regression models for multivariate analysis.The receiver operating characteristic (ROC) curve was drawn.The Youden index was calculated to analyze the predictive ability of polyp diameter for malignancy from GBPs.Results (1) Risk factors analysis of malignancy from GBPs:results of univariate analysis showed that age,polyp diameter,polyp number,chronic cholecystitis and carcinoembryonic antigen (CEA) level were related factors affecting malignancy from GBPs (t=-5.50,Z=-9.65,x2=15.92,312.65,Z=-1.78,P＜0.05).The results of multivariate analysis showed that age,polyp diameter and polyp number were independent factors affecting malignancy from GBPs (odds ratio =1.088,45.190,9.655,95％ confidence interval:0.974-1.159,4.312-121.139,0.890-117.551,P＜0.05).(2) The predictive ability of polyp diameter for malignancy from GBPs.The sensitivity and specificity predicting malignancy from GBPs were 94.9％ and 81.2％ in patients with polyp diameter =10 mm and Youden index =0.761,89.7％ and 90.6％ in patients with polyp diameter =12 mm and Youden index =0.803,84.6％ and 92.6％ in patients with polyp diameter =13 mm and Youden index =0.772,respectively.Conclusions The age,polyp diameter and polyp number are the independant factors affecting malignancy from GBPs.The malignancy possibility from GBPs is higher in patients with the age ＞ 50 years,polyp diameter ＞ 12 mm,solitary polyp,and should undergo surgical therapy actively.
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In order to prevent the canceration of gallbladder polyps or avoid the misdiagnosis of gallbladder cancer,the mainstream practice is cholecystectomy for polyps larger than 1 cm,while gallbladder polyps larger than 0.5 cm as an indication of gallbladder preserving surgery.The reasons for this result is that we put the diameter of more than 1 cm of gallbladder polyps as high risk factors for prediction of gallbladder carcinoma,and we ignored the characteristics of gallbladder polyps that most of them are not gallbladder cancer or are not cancerous even larger than 1 cm.We analysed the high risk factors for gallbladder cancer on the basis of variety of clinical data,and we believe that the most valuable indicator of gallbladder cancer are the growth time of gallbladder polyps,the age of the patients,the combination of gallstones,the single polyps,and the sex.Polyps diameter greater than 1 cm are not a high risk factor for gallbladder cancer.We can use these five high risk factors to manage gallbladder polyps and reduce unnecessary cholecystectomy and gallbladder preserving surgery.
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Objective To observe the effects of laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder and the effects on postoperative rehabilitation of patients. Methods 78 cases of patients with polypoid lesions of gallbladder treated in our hospital from August 2011 to November 2014 were selected as the study object. According to the order of medical treatment and hospital admission , the patients were numbered and randomly divided into laparoscopy group and combined group , with 39 cases in each group. The laparoscopy group were treated by laparoscopic cholecystectomy while the combined group were treated by laparoscopy combined with choledochoscopy gallbladder-protection surgery. The operation indicators , recovery of gastrointestinal function and incidence of postoperative complications in the two groups were observed. After discharge , the 2 groups of patients were followed up for 1 year. The improvement of postoperative digestive tract symptoms and rehabilitation of patients was observed. Results The intraoperative bleeding volume, postoperative fasting time, defecation time and hospitalization time of the combined group [(20.13 ± 7.48) mL, (0.51 ± 0.98) d, (1.20 ± 0.84) d, (1.98 ± 1.54)d] were less than those of the laparoscopy group (P <0.05); The incidence rate of complications in the combined group (10.26%) was lower than that in the laparoscopy group (33.33%) (P < 0.05); Immediately at the end of operation and 1 week after operation, VAS scores of the combined group [(4.23 ± 0.41), (2.46 ± 0.17) ] were lower than those in the laparoscopy group (P < 0.05); At the last follow-up, KPS score of the combined group increased to (89.98 ± 1.24), which was higher than that in the laparoscopy group (P < 0.05); GradeⅠpostoperative recovery in the combined group accounted for 87.18% which was higher than that in the laparoscopy group (64.10%). There was no case of grade III and the proportion was lower than that in the laparoscopy group (15.38%). The differences in proportions of grade I and III between the two groups were statistically significant (P < 0.05). Conclusion To adopt laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder , the curative effect is certain and the minimally invasive advantage is obvious. The long-term recovery effect is good and the safety is high.
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Only a few studies have evaluated the population-adjusted prevalence of gallbladder polyps (GBP). This study aimed to evaluate the changes in GBP prevalence and risk factors at a single health screening center in Korea from 2002 to 2012. Of 48,591 adults who underwent health screening between 2002 and 2012, 14,250 age- and gender-matched subjects were randomly selected to evaluate prevalence. Risk factors were analyzed between the GBP-positive and GBP-negative groups during 2002-2004 (Period A) and 2010-2012 (Period B). The annual prevalence of GBP over the 11-yr period was 5.4%. Annual prevalence increased from 3.8% in Period A to 7.1% in Period B. Male gender and obesity were independent risk factors for GBP in both periods. Hepatitis B virus surface antigen (HBsAg) positivity was a risk factor for GBP in Period A but not in Period B. The risk factors for GBP changed from HBsAg positivity to lipid profile abnormalities. Other variables including age, hypertension, diabetes, impaired fasting glucose, chronic hepatitis C virus infection, and liver function tests did not correlate with GBP. In conclusion, GBP prevalence is increasing and risk factors for GBP have changed in Korea. More attention should be paid to this issue in the future.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Gallbladder Diseases/complications , Hepatitis B/complications , Hepatitis B Surface Antigens/blood , Obesity/complications , Polyps/epidemiology , Prevalence , Republic of Korea/epidemiology , Risk Factors , Sex FactorsABSTRACT
A polypoid lesions of the gallbladder (PLGs) is defined as any elevated lesion of the mucosal surface of the gallbladder wall. Even though most of the gallbladder polyps are benign in nature, malignant polyps are found in some cases. Because advanced gallbladder cancer displays poor prognosis, early detection and appropriate early measures are important for curative treatment and improvement in long-term survival. Patients who have GB polyps are usually almost always asymptomatic and often diagnosed incidentally by abdomen CT scan or transabdominal ultrasonography (TAUS) imaging. However TAUS and CT scan can not differentiate precancerous and cancerous lesions from cholesterol polyps. To increase the diagnostic accuracy, New imanging modality is being performed. Of the available tests, the accuracy of EUS (or CEH-EUS) for the differentiation of neoplastic from nonneoplastic polyps was higher than that of transabdominal US or CT scan. The cholecystectomy should be undertaken only in cases where there are clinical signs of gallbladder polyps, polyps with diameters greater than 10 mm, fast-growing polyps, sessile polyps or wide-based polyps, patient aged over 50, concurrent gallstones, polyps of the gallbladder in fundibulum or abnormal gallbladder wall US. Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations. guidelines on the screening interval are not yet available, but follow-up with the same modality is generally recommended after 3-6 months. If there are no changes in size, contour, or vascualrity, the follow-up should be individualized; most often a follow up after another 12-24 months could be recommended up to 5 years at least.
Subject(s)
Humans , Abdomen , Cholecystectomy , Cholesterol , Diagnosis , Follow-Up Studies , Gallbladder Neoplasms , Gallbladder , Gallstones , Mass Screening , Polyps , Prognosis , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Diseases of the gallbladder are common and costly. The best epidemiological screening method to accurately determine point prevalence of gallstone disease is ultrasonography. Many risk factors for cholesterol gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstone frequency. Risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones. Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians. Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps.
Subject(s)
Adult , Female , Humans , Pregnancy , Bile , Cholecystectomy , Cholelithiasis , Cholesterol , Crohn Disease , Developed Countries , Fasting , Fibrosis , Gallbladder , Gallbladder Neoplasms , Gallstones , Hemolysis , Incidence , Indians, South American , Mass Screening , Obesity , Octreotide , Parenteral Nutrition, Total , Polyps , Prevalence , Risk Factors , Sedentary Behavior , Sodium Chloride Symporter Inhibitors , Weight LossABSTRACT
OBJETIVO: Describir las características clínicas y anatomopatológicas de los pólipos vesiculares hallados en colecistectomías realizadas en la clínica Anglo Americana entre los años 1999-2007. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo. Inició en el Departamento de Patología donde se seleccionaron fichas de pacientes con diagnóstico anatomopatológico de pólipos vesiculares que fueron colecistectomizados durante los años 1999-2007. Se procedió a revisar las historias clínicas de estos pacientes para tomar datos clínicos y ecográficos. Se utilizó Microsoft Excel para crear una base de datos y analizarlos. RESULTADOS: La prevalencia de pólipos vesiculares fue 10%(172) de un total de 1707 vesículas revisadas. De los 172 pólipos encontrados, 95.4% correspondieron a pólipos colesterolósicos, 4% a adenomatosos y 0.6% a hiperplásicos. El 32.25% de los pólipos vesiculares hallados tuvieron un tamaño ≥10mm. El 90% de los pólipos vesiculares ≥10mm fueron colesterolósicos y el 10%, adenomatosos. No se encontró ningún pólipo maligno. CONCLUSIONES: La gran mayoría de pólipos vesiculares hallados fueron colesterolósicos e incluso de los que tienen tamaño ≥10mm, el 90% son también colesterolósicos. La decisión de practicar una colecistectomía en estas circunstancias debe ser individualizada y discutida claramente con el paciente, teniendo en cuenta factores como tamaño y velocidad de crecimiento de la lesión.
OBJECTIVE: To describe the clinical and anatomopathologic characteristics of gallbladder polyps found in patients who underwent cholecystectomy at Clinica Anglo Americana for the 1999-2007 period. MATERIALS AND METHODS: Descriptive and retrospective study that started at Pathology Department where patients with anatomopathologic finding of gallbladder polyps who underwent cholecystectomy for the 1999-2007 period were selected. Clinical records were reviewed to take ultrasonographic, anat-omopathologic and clinical characteristics, which were included and studied in a data base in Microsoft Excel. RESULTS: Gallbladder polyps were found in 172 (10%) of 1707 gallbladders that were analized. Cholesterolosic polyps were found in 95.4% of the cases, 4% were adenomas and 0.6% were hyperplasic polyps. Gallbladder polyps ≥10mm were found in 32,25% of the cases. A 90% of these polyps were cholesterolosic and a 10% were adenomas. No malign polyps were found in this study. CONCLUSIONS: The vast majority of gallbladder polyps, including the ≥10mm group, were cholesterolosic. The physician decision to remove the gallbladder must be individualized and discussed with each patient, considering gallbladder polyp characteristics such as size and growth rate of the lesion.
Subject(s)
Humans , Male , Female , Cholecystectomy , Pathological Conditions, Anatomical , Polyps , Gallbladder , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: Although there are various reports on the prevalence of gallbladder (GB) polyp according to the race or area, there is no report on Daegu and Gyeongbuk provinces. Therefore, we investigated the prevalence and related risk factors of GB polyp in health screening population of Daegu and Gyeongbuk provinces. METHODS: Of 28,911 adult health screening examinees from January 1997 to May 2003, age and gender-matched 8,008 (3,896 men, 4,112 women) were randomly selected to evaluate the prevalence. Independent risk factors were analyzed by comparing various variables between the GB polyp positive and negative groups. RESULTS: The prevalence of GB polyp was 2.2% (175/8,008). Those were 2.7% (104/3,896) among men and 1.7% (71/4,112) among women. Independent risk factors related with GB polyp were male gender (OR 1.434, p<0.001), obesity (OR 1.237, p=0.024), and hepatitis B carrier (OR 1.888, p<0.001) CONCLUSIONS: Prevalence of GB polyp in Daegu and Gyeongbuk provinces is 2.2%. Male, obesity, and hepatitis B carrier may be the risk factors related with GB polyp in this region.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Gallbladder Diseases/epidemiology , Korea/epidemiology , Polyps/epidemiology , Prevalence , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND/AIMS: The size and number of gallbladder polyps are used to differentiate between benign and malignant lesions before surgery. The objective of this study was to determine which polyps of the gallbladder should be operated upon and whether laparoscopic cholecystectomy is a safe and feasible method for gallbladder polypoid lesions of the gallbladder. METHODS: Data from 68 patients with polypoid lesions of the gallbladder treated by laparoscopic cholecystectomy at the Department of surgery, Pusan National University Hospital were reviewed retrospectively. the gallbladders were classified into four histologic groups. Clinical features, maximal diameter, and the number of lesions were compared among the groups. RESULTS: The mean maximal diameter of neoplasms was significantly larger than that of lesions in the nonneoplasm group. All four malignant lesions that were detected measured at least 1.5 cm. Univariate analysis showed that polypoid lesions of the gallbladder with neoplastic lesion correlated significantly with age, sex, and number of the lesions. Univariate analysis also showed that malignancy in polypoid lesions of the gallbladder correlated significantly with age, size, and number of the lesions. Multivariate logistic regression analysis showed that the age of the patient and the size of the lesion (> or =1.0 cm) are two independent factors in predicting neoplastic lesions in polypoid lesions of the gallbladder. The size of the lesion (> or =1.5 cm) is the only independent factor in predicting malignancy in the polypoid lesions of the gallbladder as shown by multivariate logistic regression analysis. CONCLUSION: Laparoscopic cholecystectomy is a safe and feasible method for gallbladder polypoid lesions. Neoplastic change in polypoid lesions of the gallbladder should be considered when a patient older than 50 years of age has a polypoid lesion larger than 1.0 cm. Cancer should be suspected when a polypoid lesion of the gallbladder is larger than 1.5 cm.