Mahmoud Askar Ahmed, Akula Bharathi, Arif Aftab Mohammed, Isherwood John, Issa Eyad, Bhardwaj Neil, Dennison Ashley, Garcea Giuseppe
Department of Hepatopancreatobiliary Surgery, University Hospitals of Leicester, Leicester, GBR.
Department of Hepatopancreatobiliary Surgery, University hospital of Leicester, Leicester, GBR.
Cureus. 2024 Sep 26;16(9):e70223. doi: 10.7759/cureus.70223. eCollection 2024 Sep.
Aim To assess the effect of laparoscopic cholecystectomy (LC) in relieving the biliary type symptoms in patients with gallbladder polyps (GBPs) and to determine the positive and negative predictive values (PPV, NPV) of abdominal ultrasound (US) for the pre-operative detection. Methods The data were retrieved from our tertiary hepatobiliopancreatic (HPB) center database for all patients who had an LC as a treatment for symptomatic GBPs between 2013 and 2022. The pre-operative US and postoperative histology reports were reviewed. Patients were contacted and asked to fill in a questionnaire using the Accurx® software (Accurx UK) asking them about the degree of symptom relief following their surgery. Subsequently, the responses were correlated with polyp size, and the data collected was used to determine the PPV and NPV of the US examination for the identification of GBPs. Results Seventy patients had GBPs reported on pre-operative US and/or postoperative histology reports. Thirty-six patients (51.4 %) replied to our questionnaire. Twenty-four patients (66.6 %) reported complete relief of pain post-operatively, eight (22.2%) had a significant improvement of symptoms but still had ongoing mild discomfort, two (5.5%) are still experiencing discomfort which has not reduced following their cholecystectomy and two patients (5.5%) were unsure of the degree of improvement. Overall, 89 % of the patients reported a complete or major improvement in their symptoms after LC. Nine patients with putative GBPs on their pre-operative US had negative final histology while 26 patients whose initial US report showed only gallstones (GSs), had GBPs confirmed by their histology report. The prevalence of GBPs in our snapshot cohort is 21.6%, with a PPV of US of 83.02%, an NPV of 90.37%, and an accuracy for detecting GBPs of 89.16%. Conclusion Although LC continues to be the gold standard for the management of symptomatic gallstone disease, assessing the benefit of symptomatic GBPs is presently lacking. This study has demonstrated that the majority of patients with symptomatic GBPs experience a complete resolution or major improvement of their symptoms following surgery. Furthermore, a significant number of patients undergoing surgery for putative GSs will have GBPs demonstrated following histological examination, suggesting that these two conditions either coexist or the pre-operative assessment by US is not sufficiently reliable. Randomized controlled trials are needed to define the cohorts who require surgery or are most likely to benefit.
目的 评估腹腔镜胆囊切除术（LC）对缓解胆囊息肉（GBP）患者胆道类型症状的效果，并确定腹部超声（US）术前检测的阳性和阴性预测值（PPV、NPV）。方法 从我们的三级肝胆胰（HPB）中心数据库中检索2013年至2022年间所有因有症状的GBP接受LC治疗的患者的数据。回顾术前超声和术后组织学报告。联系患者并要求他们使用Accurx®软件（Accurx英国）填写一份问卷，询问他们术后症状缓解的程度。随后，将回答与息肉大小相关联，并使用收集到的数据确定超声检查识别GBP的PPV和NPV。结果 70例患者术前超声和/或术后组织学报告中有GBP记录。36例患者（51.4%）回复了我们的问卷。24例患者（66.6%）报告术后疼痛完全缓解，8例（22.2%）症状有显著改善但仍有持续的轻度不适，2例（5.5%）胆囊切除术后仍有未减轻的不适，2例患者（5.5%）不确定改善程度。总体而言，89%的患者报告LC术后症状完全或有显著改善。9例术前超声诊断为疑似GBP的患者最终组织学检查为阴性，而26例最初超声报告仅显示胆结石（GS）的患者，其组织学报告证实有GBP。我们的快照队列中GBP的患病率为21.6%，超声的PPV为83.02%，NPV为90.37%，检测GBP的准确率为89.16%。结论 尽管LC仍然是有症状胆结石疾病治疗的金标准，但目前缺乏对有症状GBP获益情况的评估。本研究表明，大多数有症状GBP的患者术后症状完全缓解或有显著改善。此外，大量因疑似GS接受手术的患者组织学检查后会发现GBP，这表明这两种情况要么共存，要么超声术前评估不够可靠。需要进行随机对照试验来确定需要手术或最可能获益的人群。
