Pólipos da vesícula biliar. Como e quando tratar?

Abstract

objectIve. The objective of this study was to determine the correct therapeutic management for patients with gallbladder polyps (GPs), what type of surveillance should be employed and how to differentiate between benign and malignant polyps in addition to also to providing reassurance in cases of "cancerophobia". Study design: This was a 5-years retrospective study. Location: The study was conducted at a Surgery Department at the Hospitais da Universidade de Coimbra. Population: We analyzed all patients operated on at the Surgery Service II from January 2003 to December 2007 who had had a preoperative diagnosis of GP. Methods. Clinicopathological correlations were traced for all patients. The following were analyzed: demographic data, clinical presentation, principal symptoms, associated pathologies, supplementary tests and diagnoses. results. We studied 93 patients, 91 of whom had benign polyps and two of whom had malignant polyps. Of the 91 benign polyps, 73 (78.5%) were cholesterol polyps, 14 (15%) were hyperplastic and two (2.2%) were adenomas. Two (2.2%) patients had malignant polyps, both adenogallbladder carcinomas. The mean diameter of benign polyps was 6 mm and 40 (43%) patients had multiple lesions. The mean diameter of malignant and premalignant polyps taken together was 18.8 mm, all were single polyps and the mean age of this patient subset was 57.7 years. conclusIon. It was concluded that the surgical option for GPs is cholecystectomy and that this should only be undertaken in cases where there are clinical signs of GP; polyps with diameters greater than 10 mm; fast-growing polyps; sessile polyps or wide-based polyps; polyps with long pedicles; patient aged over 50; concurrent gallstones; polyps of the gallbladder infundibulum or abnormal gallbladder wall ultrasound.

Diagnosis and Management of Gallbladder Polyps

“…[4] In the majority of publications in which the ratio is calculated, the incidence is more prevalent in men. [15] The sex ratio and age at the time of diagnosis of gallbladder polyps was 1.15 to 1 (male to female). [46]…”

“…There are descriptions of polyps that protrude greatly obstructing the cystic canal or the primary biliary ducts, causing acute cholecystitis or obstructive jaundice, but these are very rare complications. [1]…”

“…The poor prognosis of gallbladder carcinoma patients means it is important to differentiate between benign polyps and malignant or premalignant polyps. [1]…”

An overview of recently published medical papers in Brazilian scientific journals

“…Bagnoli et al14 verified the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast and conclude that aromatase through local estrogen synthesis in breast tissue plays an important role in breast carcinogenesis, mainly influencing MMP-2 and MMP-9 which are important participants in tumor cell invasion and dependence of their connection to CD44 for action. Matos et al49 present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007 and claim that cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. Saad et al50 have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival among patients with advanced pancreatic cancer treated with gemcitabine; they sought to confirm the prognostic role of the pretreatment level of CA 19-9 and found further evidence in favor of the concept.…”

“…Macedo et al60 determined the occurrence of hepatopulmonary syndrome in cirrhosis patients who are candidates for liver transplantation and found a high prevalence of the syndrome, which however did not correlate with any of the variables analyzed. Matos et al49 present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007 and claim that cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. The etiology of acute pancreatitis cannot be found by clinical, biological and imaging investigations in 30% of these cases.…”