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Abstract
Background/Aims
It has been known that chronic trauma and inflammation of gallbladder (GB) mucosa by gallstones (GS) can induce epithelial dysplasia, carcinoma in situ, and invasive cancer. This study was designed to investigate the usefulness of cholecystectomy in patients with asymptomatic GS for the early diagnosis and removal of dysplasia or cancer.
Methods
From January 2004 to July 2008, the clinical records of 703 cases with GS who underwent cholecystectomy at Korea University Guro Hospital were reviewed, and the prevalence of dysplasia and cancer was analyzed.
Results
In symptomatic GS (542 cases) group, low grade dysplasia was found in 4 cases (0.74%) and high grade dysplasia in 1 case (0.18%). In asymptomatic GS (161 cases) group, low grade dysplasia was found in 4 cases (2.48%) and cancer in 2 cases (1.24%) (p=0.012 vs. symptomatic cases). Dysplasias in symptomatic GS group were not associated with polyps, but dysplasias and cancers in asymptomatic GS group were associated. Patients with asymptomatic GS and polyps were analyzed according to the size of polyps. In those (12 cases) with larger polyps (≥1 cm), low grade dysplasia was found in 2 cases and cancer in 2 cases. And in those (12 cases) with smaller polyps (＜1 cm), low grade dysplasia was found in 2 cases.
Conclusions
Extending indication of prophylactic cholecystectomy in patients with asymptomatic GS without polyp to prevent GB dysplasia or cancer beyond the existing indication does not seem to be justifiable in Korea. However, further studies are needed in patients with asymptomatic GS and polyp of any size.
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Table 1.
Clinical Characteristics of Patients with Gallstones Undergone Cholecystectomy
Table 2.
Reasons for Cholecystectomy in Asymptomatic Gallstone Group
| Reasons of cholecystectomy | N (%) |
|---|---|
| Nonspecific symptoms | 90 (55.9) |
| Patient wanted | 31 (19.3) |
| Associated polyp | 24 (14.9) |
| Others∗ | 16 (9.9) |
| Total | 161 (100) |
Table 3.
Prevalence of Dysplasia and Cancer in Symptomatic and Asymptomatic Gallstone Groups
| Symptomatic group (n=542) | Asymptomatic group (n=161) | Total (n=703) | p value | |
|---|---|---|---|---|
| Low grade dysplasia | 4 | 4 | 8 | |
| High grade dysplasia | 1 | 0 | 1 | |
| Cancer | 0 | 2 | 2 | |
| 5 (0.92%) | 6 (3.73%) | 11 (1.56%) | 0.012 |
Table 4.
Prevalence of Dysplasia or Cancer in Symptomatic and Asymptomatic Gallstone Groups after Exclusion of Cases with Polyps
| Symptomatic group (n=520) | Asymptomatic group (n=137) | Total (n=657) | p value | |
|---|---|---|---|---|
| Low grade dysplasia | 4 | 0 | 4 | |
| High grade dysplasia | 1 | 0 | 1 | |
| Cancer | 0 | 0 | 0 | |
| 5 (0.96%) | 0 (0.00%) | 5 (0.76%) | 0.250 |
Table 5.
Prevalence of Dysplasia or Cancer in Symptomatic and Asymptomatic Gallstone Groups with Polyps according to Polyp Size
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