P-BN22 The use of virtual clinics in gallbladder polyp surveillance

Background Gallbladder polyps are common findings on ultrasound with a prevalence between 0.3-9.5%. Their significance is not clear but are theorised to have potential risk of transformation into gallbladder malignancy which have poor prognosis if not caught early. Current guidelines recommend surveillance of polyps and that laparoscopic cholecystectomy should be offered if certain criteria are met. Most patients are asymptomatic and regular reviews in clinic is time consuming for patients and adds to strain on services. This study looks at the use of virtual clinics in gallbladder polyp surveillance. Methods Since January 2019 patients identified with gallbladder polyps have been added to virtual clinic. Each patient is added to a database which is maintained by one upper GI surgeon. Current guidelines are followed: laparoscopic cholecystectomy is offered if polyps are greater than 1cm, there is an increase greater than 2mm between scans, and in high-risk groups or in symptomatic patients. All other patients are offered interval scans as per guidelines and a template letter is generated informing patients of their scan results and date of their follow up scan. Results Since January 2019, 70 patients have been identified to have gallbladder polyps. Of these 48 patients so far have benefitted from involvement from follow up in virtual clinic to date, this has resulted in 88 clinic appointments being saved. 12 patients have undergone laparoscopic cholecystectomy due to increase in size of their gallbladder polyps or secondary to symptoms. 7 patients have been lost to follow up, 2 discharged due to the gallbladder polyps disappearing and the other 49 remain under surveillance in the virtual clinic. Conclusions Long term polyp surveillance can be time consuming for both the patient and clinician. This model of a virtual clinic maintains clear communication with patients about their scan findings, the risks associated and plans for future scans. This is an efficient method of monitoring these patients that has good compliance and identifies patients appropriate for surgery.

An unusual case of a gallbladder polyp

A 63-year old female patient with a medical history of hypereosinophilic syndrome with neurological and pulmonary involvement presented for a routine follow-up. The patient was asymptomatic but a routine scheduled ultrasound showed a gallbladder polyp of 19mm. One month later this polyp had grown to 36 mm. On magnetic resonance imaging of the liver there was a suspicion of gallbladder cancer and for this reason cholecystectomy was performed. Pathology however showed eosinophilic infiltration. Serum analysis showed an increase in her eosinophil count. The diagnosis of hypereosinophilic syndrome with eosinophilic infiltration of the gallbladder was made. The dose of corticosteroids was augmented and she recovered completely post-operatively with no residual flares of other organ damage during follow up.

Gallbladder Polyp Classification in Ultrasound Images Using an Ensemble Convolutional Neural Network Model

Differential diagnosis of true gallbladder polyps remains a challenging task. This study aimed to differentiate true polyps in ultrasound images using deep learning, especially gallbladder polyps less than 20 mm in size, where clinical distinction is necessary. A total of 501 patients with gallbladder polyp pathology confirmed through cholecystectomy were enrolled from two tertiary hospitals. Abdominal ultrasound images of gallbladder polyps from these patients were analyzed using an ensemble model combining three convolutional neural network (CNN) models and a 5-fold cross-validation. True polyp diagnosis with the ensemble model that learned only using ultrasonography images achieved an area under receiver operating characteristic curve (AUC) of 0.8960 and accuracy of 83.63%. After adding patient age and polyp size information, the diagnostic performance of the ensemble model improved, with a high specificity of 88.35%, AUC of 0.9082, and accuracy of 87.61%, outperforming the individual CNN models constituting the ensemble model. In the subgroup analysis, the ensemble model showed the best performance with AUC of 0.9131 for polyps larger than 10 mm. Our proposed ensemble model that combines three CNN models classifies gallbladder polyps of less than 20 mm in ultrasonography images with high accuracy and can be useful for avoiding unnecessary cholecystectomy with high specificity.

Are metabolic syndrome and its components a risk factor for gallbladder polyps?

Background. Gallbladder polyps are usually benign lesions originating from the mucosa and are usually detected incidentally during radiological examinations or after cholecystectomy. Gallbladder polyps are common and may have malignant risk. In this study, it was investigated whether metabolic syndrome (MS) is a risk factor for gallbladder polyps. This study aimed to determine the prevalence of MS and its components in patients with gallbladder polyps. Materials and methods. We conducted a retrospective, cross-sectional study. We investigated the age, gender and past medical history of 90 adults (45 with polyps, 45 without polyps). Body height and weight, body mass index, waist circumference and laboratory data were obtained from the hospital data processing system. National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Foundation (IDF) MS diagnostic criterion were used for the diagnosis of MS. Results. 51.1 % (n = 46) of the subjects participating in the study were female and 48.8 % (n = 44) were male. The mean age was 58.79 ± 15.70 years. MS was found in 56.7 % (n = 51) of the cases according to the criteria of NCEP-ATP III and, in 64.4 % (n = 58) of the cases according to the IDF criteria. In patients with a gallbladder polyp, MS was detected in 55.55 % according to the criteria of NCEP-ATP III and in 66.66 % according to the IDF criteria. The rates of MS were not similar in the gallbladder polyp group and control group (p > 0.01). Abdominal obesity was found to be a risk factor for the development of gallbladder polyp (odds ratio: 14.23, 95% CI: 1.751–15.722; p < 0.01). Although it was not statistically significant, low HDL and hypertension were detected approximately 2 times higher in patients with gallbladder polyps than in the control group. Conclusions. While MS is not associated with the development of gallbladder polyp, obesity is seen as a sole risk factor.

Perbedaan Sonopattern Ultrasonografi Kandung Empedu pada Kasus Cholelithiasis & Galbladder Polyp

On ultrasound examination of the gallbladder Cholelithiasis and Gallbladder Polyp usually have similar results but have their own characteristics that can differentiate. In the image results Cholelithiasis, which is usually called gallstones, has a characteristic Sonopattern Hyperechoic with an Acousstic Shadow behind it, where when using the technique the patient's position changes the stone according to the direction of Earth's gravity. While the results of the Gallbladder Polyp image, which is a tumor protrusion attached to the gallbladder wall, has the characteristic Sonopattern Hyperecoic without an acoustic shadow behind it, where when using the technique the patient's position changes not according to the direction of Earth's gravity. In both cases, the presence or absence of an acoustic shadow behind it is based on the density of the tissue that the sound waves pass through from the ultrasound device, so that when passing through the stone, the acoustic shadow is more visible than when passing through the tumor tissue.. Keywords: sonopattern ultrasound; cholelithiasis; gallbladder polyp ABSTRAK Pada pemeriksaan USG kandung empedu Cholelithiasis dan Gallbladder Polyp biasanya memiliki hasil gambaran yang serupa tetapi memiliki ciri khasnya masing-masing yang dapat membedakan. Pada hasil gambaran Cholelithiasis yang biasa disebut batu empedu memiliki ciri khas Sonopattern Hyperechoic dengan Acousstic Shadow di belakangnya, ketika menggunakan teknik dengan posisi pasien yang berubah batu mengikuti arah gravitasi bumi. Sementara pada hasil gambaran Gallbladder Polyp yang merupakan tonjolan tumor yang menempel pada dinding kandung empedu memiliki ciri khas Sonopattern Hyperecoic tanpa Accoustic Shadow dibelakangnya, dimana ketika menggunakan teknik dengan posisi pasien yang berubah tidak mengikuti arah gravitasi bumi. Pada kedua kasus ini ada tidaknya Accoustic Shadow di belakangnya didasari oleh kepadatan jaringan yang dilalui oleh gelombang suara dari alat USG, sehingga saat melewati batu lebih tampak Accoustic Shadow dibandingkan saat melewati jaringan tumor. Kata kunci: sonopattern ultrasound; cholelithiasis; gallbladder polyp