The effect of smoking on the risk of gallbladder cancer: a meta-analysis of observational studies.

BACKGROUND: Cigarette smoking has been shown to cause many nonpulmonary cancers, including those of liver, pancreas and bladder. However, results of epidemiologic studies examining the association between smoking and gallbladder cancer (GBC) have been mixed. To clarify the association of cigarette smoking and GBC, we performed a meta-analysis of observational studies. METHODS: A literature search was performed using Medline (from 1 January 1966) and Embase (from 1 January 1974), through 31 January 2012, and by manually searching the reference lists of pertinent articles. Summary relative risks (SRRs) with corresponding 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS: A total of 11 articles (10 case-control and one prospective cohort studies) were used in this meta-analysis, which is based on a total of 1178 GBC cases. Analysis of 11 studies found that smokers had an increased risk of GBC development, compared with nonsmokers (SRRs 1.45, 95% CIs, 1.11-1.89). There was moderate heterogeneity among studies (Q=18.15, P=0.052, I2 =44.9%). These increased risks were independent of alcohol use and a history of gallstones. No significant publication bias was found. CONCLUSION: Although the current evidence supports a positive link between cigarette smoking and risk of gallbladder cancer, additional population-based studies, particularly cohort studies, are needed before definitive conclusions can be drawn.

MPS in diagnosing and treating gastrointestinal submucosal protrusive lesions / 中华消化内镜杂志

Objective To evaluate the value of miniprobe sonography (MPS) in diagnosing gastrointestinal submucosal protrusive lesions and selecting the indicated manual for treatment. Methods According to the sizes, properties, and depth of SMTs in the gastrointestinal tract detected by the MPS, different methods of resection were performed. Results Of 24 cases, 11 SMTs lying in submucosa under 2cm in diameter (2 benign gastrointestinal stromal tumors, 3 lipomas, 5 cysts, 1 granular cell tumor) were attempted with EMR or argon plasma coagulation (APC) ; there were no complications of hemorrhage or perforation. Thirteen SMTs lying in muscularis propria or with size of SMTs above 2 cm in diameter (4 malignant GISTs, 6 benign GISTs, 1 lipoma, 2 aberrant pancreas) were performed by surgical resection. Preoperative diagnoses of SMTs by MPS were consentient with their histological diagnoses. Conclusion MPS may detect the size, property, and depth of SMTs in the gastrointestinal tract and is helpful in selecting indicated cases for endoscopic resection. Endoscopic therapy of SMTs lying in mucosa or submucosa under 2cm in diameter is a safe and effective procedure.