Gall Bladder Polyps : A Paradigm Shift – Need for Reappraisal of Guidelines

Background : Gall Bladder Polyps are mucosal lesions that project from the Gall Bladder wall into the Gallbladder lumen. They form morphologically distinct lesion/s with internal characteristics different than that of neighboring structures as verified by microscopic examination. About 4-6% are picked up clinically, 2-12% in Cholecystectomy specimens and 4% on Ultrasound. Materias and Methods : A three calendar year retrospective single surgical unit study compromised of 1442 cholecystectomies performed for benign Gall Bladder Disease. The patient were subjected to Ultrasound of abdomen for diagnosis and routine clinic work up. The Gall Bladders Harboring Polyps were examined grossly for site ,number, and microscopy for histological details. Results : In a total number of 40 cases of Gall Bladder Polyp, females outnumbered males. This series spreads over age groups of 3rd decade - 9th decade, most of the patients were seen in 6th decade of life. Youngest patients were 27 years old and oldest one was 85 years old. Incidentally, none of the old patients had evidence of malignancy on histopathology in their Gall Badder Polyp, only 2% were necessitated for a pre-operative diagnosis of Gall Bladder Polyps alone. Rest required it for presence of Gallstones with or without Polyp. None of >10mm size showed any malignant change on histopathological examination. On the Contrary, among the polypoid lesions <10mm size, one polypid lesion (7mm) showed a malignant change (Carcinoma in situ) Conclusion : A predictive model for neoplastic potential of Gall Bladder Polyp may support clinical decision to achieve an ideal therapeutic outcome. Hence a need for reappraisal of management guidelines.

Clinical effect of low frequency ultrasound combined with high frequency ultrasound in the diagnosis of gallbladder polypoid lesions / 中国综合临床

Objective To explore the clinical effect of low frequency ultrasound combined with high frequency ultrasound in the diagnosis of polypoid lesions of gallbladder,and to provide reference for clinical diagnosis. Methods From January 2013 to January 2017,87 patients with gallbladder polypoid lesions in Hankou Hospital were selected as the subjects,all the patients were checked by low frequency ultrasound and high frequency ultrasound,the results were compared with postoperative pathological findings. The diagnostic effect were compared between the low frequency ultrasound and low frequency ultrasound combined with high frequency ultrasound,and the consistency between the two inspection methods and postoperative pathological results was analyzed. Results The postoperative pathological report showed that among the 87 patients,59 cases ( 67. 82%) had gallbladder polyp, 6 cases ( 6. 90%) had adenomyosis, 10 cases ( 11. 49%) had gallbladder adenoma, 12 ( 13. 79%) had small nodular gallbladder cancer, 65 ( 86. 67%) had benign polypoid lesions,73 (97. 33%) had low frequency ultrasound combined with high frequency ultrasound. The accuracy of combined high-frequency ultrasound in the diagnosis of benign gallbladder polypoid lesions was significantly higher than that of low frequency ultrasound (χ2＝5. 797,P＜0. 05); the specificity and positive predictive value of combined low frequency ultrasound and high frequency ultrasound in the diagnosis of benign gallbladder polypoid lesions were significantly higher than those of low frequency ultrasound(90. 00%and 41. 18%,97. 33% and 86. 67%) . The difference was statistically significant ( χ2 ＝6. 217, 5. 797, P＝0. 013,0. 016). Conclusion Compared with low frequency ultrasound,low frequency ultrasound combined with high frequency ultrasound improves the differential diagnosis effect of gallbladder polypoid lesions,which is worthy of clinical attention.

Treatment of polypoid lesions of gallbladder by Traditional Chinese Medicine / 国际中医中药杂志

This article reviewed literatures on the treatment of polypoid lesions of gallbladder(PLG) with Traditional Chinese Medicine(TCM) in recent years. The research showed that TCM has satisfied therapeutic effects on PLG, which can avoid unnecessary operation. But the systemic theoretic and experimental studies have been insufficient, and further studies are needed.

Operation indications for polypoid lesions of gallbladder / 国际外科学杂志

Objective To investigate the operative indications for polypoid lesions of gallbladder(PLG) and avoid cholecystectomy for PLG without operation signs.Methods Retrospective analysis of 828 cases of PLG confirmed by pathologic examination was made.Results (1)Cancer should be suspected when a patient is older than 50 years or has a polypoid lesion larger than 1.0 cm.(2)The cholecystectomies for PLG accounted for 2.7%-7.1%of all cholecystectomies in the corresponding period,and cholesterol polyps accounted for 86.11%of all PLG,and carcinoma of gallbladder accounted for 1.92%of all PLG.Conclusion At present most of PLG accepting cholecystectomy are cholesterol polyps,so the high-risk factors of the neoplastic polyps and the operative indications for PLG should be considered deliberately.