scholarly journals P-BN36 Trends in Management of Gall Bladder Polyps Over 10 Years

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Tom Richardson ◽  
Vithurshanan Karunanithy ◽  
Akshay Kumar ◽  
Sudeep Thomas ◽  
Saad Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Incidental Finding ◽  
Radiological Finding ◽  
District General Hospital ◽  
Strong Negative Correlation ◽  
Number Of Patients ◽  
Poor Understanding ◽  
Classification Of Diseases ◽  
International Statistical Classification

Abstract Background Gall Bladder (GB) polyps are abnormal growths on the inner lining that project into the lumen of the GB. They are a rare incidental radiological finding, with a prevalence ranging from 0.3% to 9.5%. The majority of these turn out to be pseudopolyps, however, correct follow up and management is essential to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We hypothesised that a lack of familiarity and poor understanding of the significance of GB polyps, along with the fact that they are frequently noted as an incidental finding by non-surgical specialties, has led to variable management of GB polyps. In order to investigate this, we carried out a retrospective analysis of the management of GB polyps at our large district general hospital over the last 10 years. Methods Patients were identified for this retrospective ten-year cohort study from our database by identifying all patients coded under the ‘International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder’. Patients with other diagnoses, such as gall bladder dysfunction, were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). These records facilitated review of emergency attendances, clinic letters, investigations, and histological results for those diagnosed with a gall bladder polyp. Analysis was performed using Microsoft Excel. Results A total of 154 GB polyps were identified, of which general surgeons diagnosed 63% and 74% went on to have further management.  11% of patients in our cohort proceeded straight to laparoscopic cholecystectomy, 33% underwent planned surveillance, 20% had unplanned scans and 12% were either followed up with the GP or referred back to clinic. A further 26% were discharged. In total, 35% of patients ultimately had a laparoscopic cholecystectomy and the average time from diagnosis to operation was 19 months. There was a strong negative correlation (-0.72) in reduction in time to operation over the 10-year study period. We also identified a decline in patients being followed up over time (-0.14) and in patients receiving no further management post diagnosis (-0.19). Conclusions Management of GB polyps has historically been and continues to be very variable, however, over our 10-year study period we have identified a trend towards operating earlier, with more patients being listed for surgery straight from diagnosis, and more having a shorter period of surveillance. In our cohort there has been no change in number of patients who have further planned surveillance imaging after diagnosis or in numbers of patients discharged with no further investigation or management. We postulate that this variability in management may be due to the fact that GB polyps are often identified as an incidental finding by non-surgical specialists, together with a general lack of awareness of current guidelines and a poor understanding of the pathophysiology.

scholarly journals P-BN37 Audit of the Management of Gall Bladder (GB) Polyps according to European Joint Guidelines (EJG), 2017

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vithurshanan Karunanithy ◽  
Tom Richardson ◽  
Akshay Kumar ◽  
Sudeep Thomas ◽  
Saad Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Radiological Finding ◽  
Positive Trend ◽  
Surgical Specialty ◽  
Significant Difference ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
Over Time

Abstract Background Gall Bladder (GB) polyps are abnormal growths of the inner lining that project into the lumen. They are a rare incidental radiological finding, with prevalence ranging from 0.3% to 9.5%. The majority of these frequently turn out to be pseudopolyps, however, correct follow up and management is essential as to ensure that true polyps, which may be malignant or have malignant potential, are not missed. EJG on the subject, published in 2017, tried to address controversial issues including which patients require cholecystectomy, which patients require follow up and how frequently this should be. We carried out an audit assessing adherence of our center’s management of GB polyps to the EJGs. Methods Patients were identified for this retrospective ten year cohort study bv identifying patients listed under ‘International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder’ on our database. Patients with other diagnoses, such as gall bladder dysfunction were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). EPRs facilitated review of emergency attendances, clinic letters, investigations and histological results for those diagnosed with a gall bladder polyp. Analysis was performed with Microsoft Excel. Results Since publication of the guidelines, 71 patients were diagnosed with a polyp. Of these, 73% were diagnosed by general surgeons and only 36% were managed according to the guidelines. We did, however, identify a strong positive trend (0.9) in improved adherence to guidelines over time. We found that guidance was more likely to be followed if the polyp was >10mm versus smaller (p < 0.01). 18% of patients (50% of those adherent to guidelines) were booked straight for laparoscopic cholecystectomy but there was a much poorer adherence to guidance concerning surveillance of polyps. There was no statistically significant difference (p = 0.32) in adherence to guidance when comparing management by surgeons versus non-surgeons. Conclusions Adherence to EJG’s overall is poor in our cohort. The adherence has improved over time, and at 3 years post introduction is 62% compared to an average of 35%. The guidance is also best followed when laparoscopic cholecystectomy is indicated straight from diagnosis compared to patients who meet the criteria for surveillance.  Initial diagnosis by a non-surgical specialty does not affect adherence to guidance. Better local education amongst junior surgical grades about GB polyps, as well as increased awareness of the EJG’s may improve adherence to guidance. Further research into risk stratification and the optimal follow up of GB polyps may make surveillance guidance easier to follow and further improve compliance.

scholarly journals P-BN38 Patient Outcomes Following Laparoscopic Cholecystectomy after a Diagnosis of Gall Bladder (GB) Polyp over 10 Years

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Tom Richardson ◽  
Vithurshanan Karunanithy ◽  
Akshay Kumar ◽  
Sudeep Thomas ◽  
Saad Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Patient Outcomes ◽  
Radiological Finding ◽  
Wait Time ◽  
Chronic Cholecystitis ◽  
Histological Findings ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
International Statistical Classification

Abstract Background Gall Bladder (GB) polyps are elevations of the GB wall that project into the lumen. They are a rare incidental radiological finding with prevalence of 0.3% to 9.5%. Although the majority of these may be pseudopolyps correct follow up and management is essential as to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We conducted a retrospective study assessing patient factors that may predispose to the finding of true polyps. Patient outcomes including histological findings as well as ongoing symptoms and further investigations or emergency attendances were also assessed. Methods Patients were identified for this retrospective ten year cohort study using International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder. Patients with other diagnoses such as gall bladder dysfunction were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). EPR allowed for review of emergency attendances, clinic letters, investigations and histological results for those diagnosed with a gall bladder polyp. Analysis was performed with Microsoft Excel. Results 35% patients had a laparoscopic cholecystectomy and the average wait time for surgery was 19 months but only 11% of patients were found to have true GB polyps on histology. Other histological findings included chronic cholecystitis (96%), cholesterolsis (33%) and stones 35%. Only 12% of those booked straight to laparoscopic cholecystectomy re-presented post operatively compared to 37% of those operated on after a period of surveillance.  Patients booked straight for laparoscopic cholecystectomy, or diagnosed with polyps >10mm in size, were statistically more likely to have a true GB polyp (P < 0.05), however, gender, ethnicity, and whether an isolated polyp or multiple were diagnosed made no statistical difference to detection of a true polyp (P > 0.05). Conclusions From this series of patients true polyps are most likely to be identified if it is larger than 10mm at diagnosis and operated on straight away. 96% of all patients, however, displayed histological features of chronic cholecystitis. This suggests that proceeding to laparoscopic cholecystectomy straight from diagnosis of a GB polyp can be justified. Only 1patient in our cohort returned normal GB histology.. Following diagnosis of a GB polyp, the option of operation versus surveillance should be discussed wirth individual patients and decisions based on assessment of risks and benefits should be made. Further research will help identify those with a predisposition to high-risk true polyps.

scholarly journals Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017

2020 ◽  
Author(s):  
Arne Jorma Speidel ◽  
Lena Woelfle ◽  
Benjamin Mayer ◽  
Carsten Posovszky
Keyword(s):  
Foreign Body ◽  
Linear Regression Analysis ◽  
Diagnostic Procedures ◽  
Harmful Substance ◽  
Female Ratio ◽  
Number Of Children ◽  
Retrospective Data Analysis ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
International Statistical Classification

Abstract Background: Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of on different object categories over a 13-year time period. Methods: A structured retrospective data analysis of patients who presented in between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed.Result: In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n=619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p<0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2=0.57; b=0.753; p=0.003). The annual rate of complications also increased significantly (R2=0.42; b=0.647; p=0.017).Conclusion: We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.

scholarly journals Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017

2020 ◽  
Author(s):  
Arne Jorma Speidel ◽  
Lena Woelfle ◽  
Benjamin Mayer ◽  
Carsten Posovszky
Keyword(s):  
Foreign Body ◽  
Linear Regression Analysis ◽  
Diagnostic Procedures ◽  
Harmful Substance ◽  
Female Ratio ◽  
Number Of Children ◽  
Retrospective Data Analysis ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
International Statistical Classification

Abstract Background: Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of on different object categories over a 13-year time period.Methods: A structured retrospective data analysis of patients who presented in between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed.Result: In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n=619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p<0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2=0.57; β=0.753; p=0.003). The annual rate of complications also increased significantly (R2=0.42; β=0.647; p=0.017).Conclusion: We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.

scholarly journals Microflora of gall bladder bile in patients undergoing laparoscopic cholecystectomy

2018 ◽  
Vol 5 (8) ◽  
pp. 2876 ◽  
Author(s):  
Prabhu T. ◽  
Chandan C. S. ◽  
Sudarsan S.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Room Temperature ◽  
Gallstone Disease ◽  
Gastric Surgery ◽  
Dietary Factors ◽  
Culturable Bacteria ◽  
E Coli ◽  
Number Of Patients ◽  
High Prevalence

Background: Gallstone disease is one of the most common problem affecting the digestive tract. The conditions that predispose to the development of gallstones are obesity, pregnancy, dietary factors, Crohn’s disease, gastric surgery, terminal resection, hereditary spherocytosis, sickle cell disease, and thalassemia. The incidence is four times higher in women than in men with high prevalence among the age group of 30-40 years. Bacteria are commonly found in inflamed gallbladder and in patients with cholelithiasis, whereas evidence suggests that normal bile is sterile. So, exploring and identifying the microflora of gallbladder bile helps to choose appropriate antibiotics.Methods: Minimum of 50 Patients admitted under General Surgery, who are scheduled to undergo laparoscopic cholecystectomy. Five ml of bile will be aspirated from the gall bladder during laparoscopic cholecystectomy. The samples will be transferred onto a plain sterile container and then transferred at room temperature in an hour to the laboratory for culture.Results: In the present study 50 patients were evaluated for culture and gall bladder bile. Out of which maximum number of patients were clustered between 31-40 years. In the present study out of 50 patients, 34 (68%) were females and 16 (32%) were males. In the present study We found total of 33 (66%) yellow stones, 13 (26%) were black in colour and 4(8%) were brown stones. In this study bile culture was showing growth of the following organisms. The commonest organism was E. coli (64%) followed by Klebsiella (25%) and Enterococcus (11%).Conclusions: Bactibilia has long been known to be associated with biliary tract diseases and culturable bacteria in bile can represent a state of asymptomatic bactibilia which can disseminate after any intervention causing infective complication. Exploring the microflora of gall bladder bile important role in choosing the appropriate antibiotic to prevent complications.

scholarly journals Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Arne Jorma Speidel ◽  
Lena Wölfle ◽  
Benjamin Mayer ◽  
Carsten Posovszky
Keyword(s):  
Foreign Body ◽  
Linear Regression Analysis ◽  
Diagnostic Procedures ◽  
Harmful Substance ◽  
Female Ratio ◽  
Number Of Children ◽  
Retrospective Data Analysis ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
International Statistical Classification

Abstract Background Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of different object categories over a 13-year time period. Methods A structured retrospective data analysis of patients who presented between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed. Result In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n = 619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p < 0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2 = 0.57; β = 0.753; p = 0.003). The annual rate of complications also increased significantly (R2 = 0.42; β = 0.647; p = 0.017). Conclusion We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.

Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie

2020 ◽  
Vol 48 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Carolin Szász-Janocha ◽  
Eva Vonderlin ◽  
Katajun Lindenberg
Keyword(s):  
Internet Use ◽  
Health Problems ◽  
Reliable Change Index ◽  
Gaming Disorder ◽  
Statistical Classification ◽  
Reliable Change ◽  
Classification Of Diseases ◽  
International Statistical Classification

Zusammenfassung. Fragestellung: Das junge Störungsbild der Computerspiel- und Internetabhängigkeit hat in den vergangenen Jahren in der Forschung zunehmend an Aufmerksamkeit gewonnen. Durch die Aufnahme der „Gaming Disorder“ in die ICD-11 (International Statistical Classification of Diseases and Related Health Problems) wurde die Notwendigkeit von evidenzbasierten und wirksamen Interventionen avanciert. PROTECT+ ist ein kognitiv-verhaltenstherapeutisches Gruppentherapieprogramm für Jugendliche mit Symptomen der Computerspiel- und Internetabhängigkeit. Die vorliegende Studie zielt auf die Evaluation der mittelfristigen Effekte nach 4 Monaten ab. Methodik: N = 54 Patientinnen und Patienten im Alter von 9 bis 19 Jahren (M = 13.48; SD = 1.72) nahmen an der Frühinterventionsstudie zwischen April 2016 und Dezember 2017 in Heidelberg teil. Die Symptomschwere wurde zu Beginn, zum Abschluss der Gruppentherapie sowie nach 4 Monaten anhand von standardisierten Diagnostikinstrumenten erfasst. Ergebnisse: Mehrebenenanalysen zeigten eine signifikante Reduktion der Symptomschwere anhand der Computerspielabhängigkeitsskala (CSAS) nach 4 Monaten. Im Selbstbeurteilungsbogen zeigte sich ein kleiner Effekt (d = 0.35), im Elternurteil ein mittlerer Effekt (d = 0.77). Der Reliable Change Index, der anhand der Compulsive Internet Use Scale (CIUS) berechnet wurde, deutete auf eine starke Heterogenität im individuellen Symptomverlauf hin. Die Patientinnen und Patienten bewerteten das Programm zu beiden Follow-Up-Messzeitpunkten mit einer hohen Zufriedenheit. Schlussfolgerungen: Die vorliegende Arbeit stellt international eine der wenigen Studien dar, die eine Reduktion der Symptome von Computerspiel- und Internetabhängigkeit im Jugendalter über 4 Monate belegen konnte.

Laparoscopic Cholecystectomy in Acute Gall Bladder Disease

1970 ◽  
Vol 24 (1) ◽  
pp. 10-13
Author(s):  
TK Maitra ◽  
NA Alam ◽  
E Haque ◽  
MH Khan ◽  
HK Chowdhury
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Early Phase ◽  
Gall Bladder Disease ◽  
Laparoscopic Procedure ◽  
Bladder Disease ◽  
Complication Of Surgery

Laparoscopic cholecystectomy is one of the procedures through which gall bladder can be removed. Acute cholecystitis was considered a contraindication for laparoscopic procedure but with time and experience this shortcoming is now overcome. Here is a study of 32 patients who were selected for laparoscopic cholecystectomy. Among them, 29 patients were operated by laparoscopic method and rest three patients were converted. This study showed the appropriate time for surgery, technical difficulties and the complication of surgery. It may be concluded that laparoscopic cholecystectomy is feasible and beneficial to the patient with acute cholecystitis in its early phase, if necessary support and expertise is available. (J Bangladesh Coll Phys Surg 2006; 24: 10-13)

scholarly journals A rare case of eosinophilic cholangiopathy

2020 ◽  
Vol 34 ◽  
pp. 205873842094175
Author(s):  
Wenya Li ◽  
Feizhao Jiang ◽  
Xiaoxiao Li ◽  
Hong Li ◽  
Zhihai Zheng
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Rare Case ◽  
Extrahepatic Bile Duct ◽  
Definitive Diagnosis ◽  
Malignant Diseases ◽  
Peripheral Eosinophilia ◽  
Number Of Patients ◽  
Accurate Treatment ◽  
Duct Excision

Eosinophilic cholangiopathy is termed as a rare, benign, and self-limiting disease. Moreover, the interference of malignant tumor to diagnosis and the changing process of disease make the accurate treatment proposal challenging. A significant number of patients require surgery for the definitive diagnosis and resolution of symptoms. We put forward a case of eosinophilic cholangiopathy infiltrating the gallbladder and bile duct with bone marrow involved, coupled with peripheral eosinophilia. The patient underwent a successful treatment using laparoscopic cholecystectomy and steroids, instead of extrahepatic bile duct excision with Roux-en-Y hepaticojejunostomy. The patient gets an accurate treatment in a minimally invasive manner. In conclusion, surgery refers to not only a diagnostic methodology but also a treatment. When the bile duct and gallbladder are involved at the same time, and cannot distinguish benign and malignant diseases, laparoscopic cholecystectomy is feasible, the effect is the same, and the symptoms of eosinophilic cholecystitis are relieved.

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