Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer

Sung Joo Jung, Jae Seon Kim, Seung Goun Hong, Moon Kyung Joo, Beomjae Lee, Ji Hoon Kim, Jong Eun Yeon, Jong Jae Park, Kwan Soo Byun, Young-Tae Bak, Wan-Bae Kim, Sang Yong Choi

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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 (> or 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.

Original languageEnglish
Pages (from-to)52-57
Number of pages6
JournalThe Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi
Volume55
Issue number1
DOIs
Publication statusPublished - 2010 Jan 1

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Cholecystectomy
Gallstones
Early Diagnosis
Polyps
Neoplasms
Korea
Cholecystitis
Carcinoma in Situ
Gallbladder
Mucous Membrane
Wounds and Injuries

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer",
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 (> or 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.",
author = "Jung, {Sung Joo} and Kim, {Jae Seon} and Hong, {Seung Goun} and Joo, {Moon Kyung} and Beomjae Lee and Kim, {Ji Hoon} and Yeon, {Jong Eun} and Park, {Jong Jae} and Byun, {Kwan Soo} and Young-Tae Bak and Wan-Bae Kim and Choi, {Sang Yong}",
year = "2010",
month = "1",
day = "1",
doi = "10.4166/kjg.2010.55.1.52",
language = "English",
volume = "55",
pages = "52--57",
journal = "The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi",
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T1 - Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer

AU - Jung, Sung Joo

AU - Kim, Jae Seon

AU - Hong, Seung Goun

AU - Joo, Moon Kyung

AU - Lee, Beomjae

AU - Kim, Ji Hoon

AU - Yeon, Jong Eun

AU - Park, Jong Jae

AU - Byun, Kwan Soo

AU - Bak, Young-Tae

AU - Kim, Wan-Bae

AU - Choi, Sang Yong

PY - 2010/1/1

Y1 - 2010/1/1

N2 - 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 (> or 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.

AB - 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 (> or 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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