Accuracy of Endoscopic Transpapillary Gallbladder Drainage with Liquid-Based Cytology for Gallbladder Disease

<b><i>Introduction:</i></b> Gallbladder carcinoma is often difficult to distinguish from benign gallbladder diseases. While the diagnostic accuracy of endoscopic transpapillary gallbladder drainage (ETGD) has been reported, these results were obtained retrospectively. This prospective study aimed to evaluate the cytological diagnostic accuracy of ETGD in patients with gallbladder disease. <b><i>Methods:</i></b> This single-arm prospective clinical trial included a total of 35 patients scheduled to undergo ETGD between March 2017 and September 2019. A 5F pigtail nasobiliary drainage tube was inserted into the gallbladder, and bile was collected over 5 times; if ETGD failed, a drainage tube was placed into the bile duct. The endpoints were, first, the cytological diagnostic accuracy of ETGD and, second, technical success rates and adverse events. <b><i>Results:</i></b> Of the 35 patients, 19 were finally diagnosed with gallbladder cancer. The success rate of ETGD tube insertion was 85.7%, and the morphological pattern of the cystic duct with the angle down and located on the right side had a significantly lower success rate for ETGD than that of other cystic duct patterns (odds ratio, 13.5; 95% confidence interval, 1.7–143.7; <i>p</i> = 0.02). Cytological samples were collected 5 times on median. The sensitivity, specificity, and accuracy in all patients were 78.9%, 100%, and 88.6%, respectively, while those in 30 patients with successful ETGD were 87.5%, 100%, and 93.3%, respectively. Adverse events occurred in 3 patients: mild pancreatitis in 1 patient and obstructive jaundice in 2 patients; all complications were resolved with conservative therapy. <b><i>Discussion/Conclusions:</i></b> Cytology using an ETGD tube is useful in differentiating benign and malignant gallbladder diseases (Clinical Trial Registry No. UMIN000026929).

Laparoscopic Cholecystectomy in Situs Inversus, a Novel Port Placement Technique, Two Case Reports, and Review of Literature

Background: Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients. Case presentation: Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown. Conclusion: Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy. Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.

Role of Interventional Radiology in Children with Biliary and Gallbladder Diseases

Biliary and gallbladder diseases in infants and children often present unique diagnostic and therapeutic challenges that require a fundamental understanding of notable biliary diseases and anatomical variations. Surgical and endoscopic approaches that are often the gold standard in adult biliary treatment may be technically challenging and are associated with a high morbidity that may warrant a multidisciplinary treatment approach. This article will provide a comprehensive overview of the biliary conditions where interventional radiology can play a vital role in the diagnosis, management, and treatment. Differences in approach or technique between children and adults will be highlighted.

Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review

The porcelain gallbladder condition describes gallbladder calcification. While gallbladder calcification is believed to increase the risk of developing gallbladder cancer, recent reports have shown that the malignancy risk is much lower than previously reported. Symptomatic patients with porcelain gallbladder should be recommended for cholecystectomy, but the management of asymptomatic patients is debatable. Based on recent evidence, prophylactic cholecystectomy is not routinely recommended in all patients with porcelain gallbladder. From the assessment of the current literature, there are three essential factors in the management of patients with porcelain gallbladder: 1) symptoms or complications of gallbladder disease, 2) calcification pattern and 3) patient age and comorbidities. Patients who do not undergo cholecystectomy should be educated about the symptoms of gallbladder diseases, and a thorough discussion is essential between patients and clinicians.

Incidental Gallbladder Cancer with the Laparoscopic Treatment in the MRI Era: An Experience at a Single Institution

Background: Magnetic resonance imaging (MRI) has been widely applied to the preoperative diagnosis of gallbladder diseases, among which laparoscopic cholecystectomy plays a critical role. Incidental gallbladder cancer (IGBC) is an unexpected guest of the patients who underwent cholecystectomy, forcing them to receive reoperation for complete resection. This study aimed to share our experience in pre-operative MRI evaluation and laparoscopic management of the IGBCs. Methods: Between January 2011 and January 2020, 7917 patients with gallbladder diseases and treated by laparoscopy were enrolled in this study. Results: A total of 49 patients were diagnosed as IGBCs. The incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gallbladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. Moreover, 73.5% and 59.2% of the IGBCs had unremarkable preoperative imaging during the ultrasonographic and MRI evaluation respectively. Also, 14 of the patients were diagnosed as gallbladder cancer (GBC) via intraoperative histological examination, and 11 received laparoscopic extensive resection after cholecystectomy.Conclusion: The patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of incidental gallbladder cancer. Preoperative MRI evaluation and intraoperative histological examination may help some incidental gallbladder cancers to achieve one-stage laparoscopic extensive resection.

HISTOPATHOLOGICAL SPECTRUM OF GALLBLADDER DISEASES IN A TERTIARY CARE CENTER – A RETROSPECTIVE STUDY

BACKGROUND: Gallbladder disease is known to affect a substantial number of people throughout the world. In India, the disease prevalence is on the rise, largely attributable to dietary & lifestyle changes, thus causing a signicant disease burden. The purpose of this study is to evaluate the varied histological manifestations of gallbladder pathology and their association with cholelithiasis. MATERIALS & METHODS: This retrospective study was conducted in the department of pathology, Kilpauk medical college from January 2018 to December 2018. The clinical data and the histopathological changes were evaluated. RESULTS: Of the 156 cases which were studied, 120 cases (77%) had gallstones. The mean age was 47 years. Females had a slight preponderance for gallbladder diseases with the Male: Female ratio being 1:2. 138 cases (89.8%) were diagnosed as chronic cholecystitis. 3 cases were diagnosed to have invasive malignancies. CONCLUSION: A diverse spectrum of diseases affect the gallbladder encompassing inammatory conditions, parasitic infections, pseudoneoplastic lesions and neoplasms. Routine cholecystectomy specimens should be evaluated meticulously as incidental ndings and diagnosis can be transformative.

Association between gallbladder diseases and Helicobacter pylori infection

Background: Helicobacter pylorus is one of the most harmful human pathogens & carcinogen. Of the world's population, more than 50% has H. pylori in their upper gastrointestinal tracts. It has been linked to a variety of extra gastric disorders. In correlation to hepatobiliary diseases; recently, the bacterium has been implicated as a risk factor for various diseases ranging from chronic cholecystitis and primary biliary sclerosing cholangitis to gall bladder cancer and primary hepatic carcinomas. However, the association between Helicobacter pylori (H. pylori) and gallbladder diseases is still vague and is controversial. Aim of study: To elucidate the association of H pylori and gallbladder diseases (calculus, acalculous, polyp), the feasibility of using rapid urease test in post-operative diagnosis, and many factors related bacterium. Subjects & methods: This case series study was conducted in Al-Kindy Teaching hospital - surgical unit during a period extended for 2 years from September 2016 to September 2018, where patients suffered from signs and symptoms of gallbladder disease were interviewed using a predesigned questionnaire including age, gender, occupation, residency and whether the drinking water was safe (purified) or not. Physical examination was done including weight status, BMI was calculated (BMI=wt. (kg)/ height (M) [2]. Provisional diagnosis of gallbladder disease was confirmed by examination, necessary laboratory investigations (Hematology, Biochemistry, and radiology). Cholecystectomy was done by using Laparoscopic cholecystectomy or open surgery. The presence of H.pylori in the mucosa of excised gallbladder was studied by using: 1) Rapid urease kit (HNAN C., LTD) 2) Histopathology & chemical analysis of associated gallstone Results: Seventy-eight patients undergoing cholecystectomy for symptomatic gallbladder disease, the gallbladder mucosa of 30 patients were tested positive for H. pylori with any one of the tests used in this study. The rapid urease test was sensitive 57.1% and specific 58.3 % of the cholecystectomies performed in our study. The mean age of studied patients was (34 ± 4 years). Females constitute 73.1% (57 out of the total 78 of patients). Of the studied cases; 26 patients (33.3%) were obese. Employee patients constitute 43 (55.1%) of patients, and 53 patients (67.9%) lived in urban areas. Purified water consumed by 61 (78.2%) of the studied population. Gallstones were detected in 56 (71.8%) of studied cases, acalculus chronically inflamed gallbladder was found in 20 (25.64%), and 2 cases (2.56%). were found to have gallbladder polyp. pylori infection was diagnosed in 30 (38.5%) of total cases (of the 56 calculus confirmed cases 48.2% were H.pylori positive, and of the 22 acalculus cases 13.6% H.pylori positive). Conclusion: Significant association is found between chronic calculus cholecystitis and H.pylori infection. While no significant association was found in correlation with acalculus cholecystitis and other gallbladder pathology. In regard to feasibility of using urease kit test, it is found that this test is sensitive 57.1%, and specific 58.3%, as such it is less accurate than histopathology study. Significant correlation was found between age, gender, weight status, and non-purified water source with H.pylori infection..