Gallbladder disease in patients with primary sclerosing cholangitis

Said, Karouk; Glaumann, Hans; Bergquist, Annika

doi:10.1016/j.jhep.2007.11.019

Cited by 167 publications

(140 citation statements)

References 41 publications

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“…Higher levels of CA19-9 were also associated with advanced tumors, usually with adverse outcomes (241,245,246) . Endoscopic retrograde colangiography with brushing citology is a method currently used for diagnostic confirmation of CC in PSC subjects with dominant strictures and/or with abnormal levels of CA19-9, but not for tumor screening due to its association with pottentialy serious adverse events (241,244,247) . The adittion of fluorescent in situ hybridization (FISH) of cytologic samples, disclosing polysomy in at least five biliary cless obtained by endoscopic brushing, was shown to enhance diagnostic accuracy for CC in PSC (68,75) .…”

Section: Screening and Management Of Cholangiocarcinomamentioning

confidence: 99%

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Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Bittencourt

Cançado

Couto

et al. 2015

Arq. Gastroenterol.

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-In order to draw evidence-based recommendations concerning the management of autoimmune diseases of the liver, the Brazilian Society of Hepatology has sponsored a single-topic meeting in October 18th, 2014 at São Paulo. An organizing committee comprised of seven investigators was previously elected by the Governing Board to organize the scientific agenda as well as to select twenty panelists to make a systematic review of the literature and to present topics related to the diagnosis and treatment of autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and their overlap syndromes. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

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Section: Screening and Management Of Cholangiocarcinomamentioning

confidence: 99%

“…Ultrasound every year is nevertheless indicate for screening of gallbladder cancer. In the presence of any solid lesion in the gallbladder cholecystectomy should be performed (247) .…”

Section: Screening and Management Of Cholangiocarcinomamentioning

confidence: 99%

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Bittencourt

Cançado

Couto

et al. 2015

Arq. Gastroenterol.

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“…1 This strategy is based on reports that most GB cancers detected in patients with PSC arise in polyps well above this size. 4,5 We here report on 2 of our patients with GB polyps detected by regular imaging surveillance within the last year. The first patient is a 38-year-old male with a 10-year history of PSC.…”

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confidence: 99%

Gall bladder polyps in primary sclerosing cholangitis: Adhere to the guidelines

2012

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We congratulate the investigators for their comprehensive review on cancer surveillance in patients with primary sclerosing cholangitis (PSC). 1 Annual ultrasound (US) examinations have been proposed by the American 2 as well as European practice guidelines, 3 and cholecystectomy is recommended for gallbladder (GB) polyps detected independent of their size. In their current review, Razumilava et al. discuss an alternative strategy consisting of repeat imaging every 3-6 months for the surveillance of polyps of less than 8 mm in size. 1 This strategy is based on reports that most GB cancers detected in patients with PSC arise in polyps well above this size. 4,5 We here report on 2 of our patients with GB polyps detected by regular imaging surveillance within the last year. The first patient is a 38-year-old male with a 10-year history of PSC. A 6-mm GB polyp was detected on surveillance US. The patient was advised to have a follow up US within 3-4 months and actually presented 6 months later. The polyp had grown to a size of 4 Â 2 cm. Surgery revealed an advanced GB adenocarcinoma with multiple small bilobar liver metastases. The second patient is a 44-year-old male with a 6-year history of PSC. He presented with a 1.6-cm GB polyp 8 months after having received magnetic resonance imaging of his liver without any pathology of the GB. Cholecystectomy revealed a tubular adenoma with focal high-grade dysplasia.These 2 cases underline that GB polyps may grow rapidly in patients with PSC. The first patient might have been cured if immediate cholecystectomy had been performed, as recommended by our current guidelines. The second patient might have developed GB cancer if a longer surveillance interval had been chosen. Yearly surveillance examinations, as recommended by the current guidelines, may not be appropriate in this high-risk population.We now recommend for our patients surveillance intervals of 6 months. More important, we should be cautious not to delay cholecystectomy in a patient with PSC and a GB polyp independent of its size, unless surgical risk far outweighs the benefit of potentially preventing a deadly cancer. Gall Bladder Polyps in Primary Sclerosing Cholangitis: Adhere to the GuidelinesTo the Editor:We thank Dr. Schramm and Dr. Lohse for their generous comments regarding our review and for sharing their experience with malignant gallbladder disease in primary sclerosing cholangitis (PSC) patients. As noted, our recommendations do differ slightly from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) guidelines, which recommend prompt cholecystectomy for gall bladder polyps of any size in PSC patients. Our review ( fig. 2) also recommends consideration of prompt cholecystectomy in PSC patients with gall bladder polyps of any size in patients with good liver function. However, in patients with impaired liver function there is a risk in performing a cholecystectomy, and using a polyp size cutoff of 0.8 cm adds specificity to th...

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“…4,5 We here report on 2 of our patients with GB polyps detected by regular imaging surveillance within the last year. The first patient is a 38-year-old male with a 10-year history of PSC.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Gallbladder polyps in primary sclerosing cholangitis: Indication for early intervention

Schramm

Lohse

2012

Hepatology

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We congratulate the investigators for their comprehensive review on cancer surveillance in patients with primary sclerosing cholangitis (PSC).1 Annual ultrasound (US) examinations have been proposed by the American 2 as well as European practice guidelines, 3 and cholecystectomy is recommended for gallbladder (GB) polyps detected independent of their size. In their current review, Razumilava et al. discuss an alternative strategy consisting of repeat imaging every 3-6 months for the surveillance of polyps of less than 8 mm in size.1 This strategy is based on reports that most GB cancers detected in patients with PSC arise in polyps well above this size. 4,5 We here report on 2 of our patients with GB polyps detected by regular imaging surveillance within the last year. The first patient is a 38-year-old male with a 10-year history of PSC. A 6-mm GB polyp was detected on surveillance US. The patient was advised to have a follow up US within 3-4 months and actually presented 6 months later. The polyp had grown to a size of 4 Â 2 cm. Surgery revealed an advanced GB adenocarcinoma with multiple small bilobar liver metastases. The second patient is a 44-year-old male with a 6-year history of PSC. He presented with a 1.6-cm GB polyp 8 months after having received magnetic resonance imaging of his liver without any pathology of the GB. Cholecystectomy revealed a tubular adenoma with focal high-grade dysplasia.These 2 cases underline that GB polyps may grow rapidly in patients with PSC. The first patient might have been cured if immediate cholecystectomy had been performed, as recommended by our current guidelines. The second patient might have developed GB cancer if a longer surveillance interval had been chosen. Yearly surveillance examinations, as recommended by the current guidelines, may not be appropriate in this high-risk population.We now recommend for our patients surveillance intervals of 6 months. More important, we should be cautious not to delay cholecystectomy in a patient with PSC and a GB polyp independent of its size, unless surgical risk far outweighs the benefit of potentially preventing a deadly cancer. Gall Bladder Polyps in Primary Sclerosing Cholangitis: Adhere to the GuidelinesTo the Editor:We thank Dr. Schramm and Dr. Lohse for their generous comments regarding our review and for sharing their experience with malignant gallbladder disease in primary sclerosing cholangitis (PSC) patients. As noted, our recommendations do differ slightly from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) guidelines, which recommend prompt cholecystectomy for gall bladder polyps of any size in PSC patients. Our review ( fig. 2) also recommends consideration of prompt cholecystectomy in PSC patients with gall bladder polyps of any size in patients with good liver function. However, in patients with impaired liver function there is a risk in performing a cholecystectomy, and using a polyp size cutoff of 0.8 cm adds specificity to the ...

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Gallbladder disease in patients with primary sclerosing cholangitis

Cited by 167 publications

References 41 publications

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Gall bladder polyps in primary sclerosing cholangitis: Adhere to the guidelines

Gallbladder polyps in primary sclerosing cholangitis: Indication for early intervention

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