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PubMed1980

The diagnosis of acute gallbladder disease by technetium-99m-labelled HIDA hepatobiliary scanning.

A series of 105 patients with upper abdominal pain suggestive of biliary colic who had hepatobiliary scans within 48 h of admission to hospital is presented. Fifty of the 65 patients with abnormal scans had operative treatment and gallbladder pathology was found in every case. Fourteen of these patients had hepatobiliary scans which also showed delayed excretion of tracer into the duodenum, and of these, 12 were found to have common bile duct stones and one a stricture of the distal end of the common bile duct. Of the 40 patients who had normal scans, 7 were found to have gallstones on further investigation. In these patients abnormal hepatobiliary scans have shown a 100 per cent correlation with gallbladder disease. We suggest that this is the investigation of choice for the surgeon contemplating early cholecystectomy on patients with suspected acute gallbladder disease.

Acute Disease↗
PubMed1986

Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation.

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.

Adult↗
PubMed1991

Laparoscopic cholecystectomy: the procedure of choice for gallbladder disease.

In an attempt to decrease patient discomfort and hasten recovery after gallbladder surgery, a laparoscopic approach to cholecystectomy has been developed. The procedure decreases hospital stay and affords a rapid return to normal activities. A large experience with laparoscopic cholecystectomy is rapidly accumulating. Our first 100 laparoscopic cholecystectomies are reviewed. Laparoscopic cholecystectomy is now the procedure of choice for the treatment of gallbladder disease.

Cholecystectomy↗
PubMed1988

Diabetes, gallbladder disease, obesity, and hypertension among Hispanics in New Mexico.

Because Hispanics in the Southwest are genetically admixed with American Indians, the hypothesis has been advanced that the excess occurrence of diabetes mellitus, obesity, and gallbladder disease in this ethnic group may be genetic in origin and results from genes derived from American Indians. This report describes the prevalence of these diseases in 1,175 adult Hispanic participants in a survey of a New Mexico community conducted in 1984-1985. At nearly all ages, the majority of subjects had a body mass index of 25 kg/m2 or greater, and a substantial proportion exceeded 30 kg/m2. The prevalence of obesity was much greater in these Hispanics than is shown in nationwide data for US whites. Diabetes mellitus was also reported more often by Hispanic subjects in this survey than by US whites nationwide. A report of gallbladder trouble or of gallbladder removal was common in both males and females; the prevalence of gallbladder removal was as high in this population as in Mexican Americans previously studied in Starr County, Texas. In spite of the high prevalence of obesity, hypertension was less frequent among the New Mexico Hispanics than is shown in nationwide data for US whites. These findings complement those of previous surveys in Texas, which have shown a notably high proportion of adults to be obese, to have non-insulin-dependent diabetes mellitus, and to have gallbladder disease. The similar epidemiology of these diseases in the Hispanics of New Mexico and the Mexican Americans of Texas supports the hypothesis that American Indian admixture underlies the development of these conditions in Hispanics throughout the Southwest.

Adolescent↗
PubMed1986

Oral contraceptives and other risk factors for gallbladder disease.

Prior studies of the association between oral contraceptives (OCs) and gallbladder disease (GBD) have yielded conflicting results. To clarify this association, a retrospective (historical) cohort study was performed on a very large data base including 1980 and 1981 Medicaid billing data from the states of Michigan and Minnesota in which 138,943 users of OCs were compared with 341,478 nonusers. The crude relative risk (RR) and 95% confidence interval (CI) for symptomatic GBD resulting in medical care was 1.14 (CI 1.09 to 1.20), with a clear dose-response (P less than 0.001). Age markedly modified the effect of OCs on GBD. The RR (CI) decreased from 3.1 (2.7 to 3.6) in women 15 to 19 years old to 1.2 (0.9 to 1.5) in women 40 to 44 years old, providing an explanation for previously conflicting reports. The effects of a number of other risk factors on GBD, some which have been controversial, were also confirmed. Adjustment for these did not change the results. In conclusion, OCs are risk factors for GBD, although the risk is of sufficient magnitude to be of potential clinical importance only in young women.

Adolescent↗
PubMed1976

Acalculous gallbladder disease: a prospective study.

A prospective study of 62 cases of acalculous gallbladder disease is reported. The clinical, radiological and pathological features are described as well as the results of cholecystectomy with a minimum follow-up of 3 years. The results compare favourably with those for calculous disease, and it is concluded that there is no clear-cut distinction between acalculous and calculous biliary disease.

Cholecystectomy↗
PubMed1995

The integrity of the cholecystokinin receptor gene in gallbladder disease and obesity.

Cholesterol gallstone disease and obesity are common and often associated disorders that could be affected by dysfunction of the receptor for cholecystokinin (CCK). Extending earlier studies that identified a defect at the level of receptor-G protein coupling in cholesterol gallstone disease, we characterized the primary structure of the gallbladder CCK receptor in patients undergoing a cholecystectomy. Represented were patients with cholesterol gallstones, as well as controls with pigment gallstones or without gallbladder disease. Both groups were composed of the range of body habitus from lean to morbidly obese. No evidence of any sequence mutation or polymorphism in the CCK receptor gene was found in any patient. This should lead future investigations of the pathogenesis of these problems toward the possible contribution of the plasmalemmal environment in affecting the association between normal receptors and G proteins.

Adult↗
PubMed1986

Treatment and prognosis of symptomatic gallbladder disease in patients with cystic fibrosis.

Twenty-four (3.6%) of 670 patients with cystic fibrosis seen over a 25-year period developed symptomatic gallbladder disease. Only four patients were less than 16 years old. Four patients presented with unusual problems, including one with acute cholangitis and two with atonic gallbladder, one of whom required cholecystectomy. Another patient was found to have cholangiocarcinoma of the gallbladder when an exploratory laparotomy was performed to investigate biliary obstruction. Twenty patients had cholelithiasis, 15 of whom underwent cholecystectomy. Only one patient had substantial pulmonary difficulties postoperatively. Patients who presented with classic biliary colic had no further symptoms after cholecystectomy. One patient developed intrahepatic stones 6 years later and required a choledochoduodenostomy. As the pulmonary status of most cystic fibrosis patients will eventually deteriorate, we recommend that serious consideration be given to performing a cholecystectomy as soon as practical after the diagnosis of symptomatic cholelithiasis. Our experience indicates that surgery can be performed safely unless pulmonary status is already extremely compromised and the patient is in overt respiratory failure.

Adenoma, Bile Duct↗
PubMed2005

Gallbladder disease in patients undergoing laparoscopic adjustable gastric banding.

BACKGROUND: Patients undergoing weight loss surgery may have an increased incidence of subsequent gallbladder disease. Management options include treatment of symptomatic disease only, preoperative ultrasonography and concurrent cholecystectomy in presence of stones, routine concurrent cholecystectomy, and choleretic therapy postoperatively. Here we report our approach to patients undergoing laparoscopic adjustable gastric banding (LAGB) and subsequent outcomes. METHODS: A retrospective review of all consecutive patients undergoing LAGB at our institution was performed. Only symptomatic patients were preoperatively evaluated for cholelithiasis and underwent concurrent cholecystectomy. No choleretics were used postoperatively. Weight loss data were collected when patients returned for band adjustments. All band adjustments were patient-driven and performed under fluoroscopic guidance. RESULTS: Between November 2001 and July 2004, 324 patients underwent LAGB. Mean starting weight was 143.6 kg (range, 92.3 to 250.5 kg), and mean body mass index was 50.5 kg/m(2) (range, 35.6 to 80 kg/m(2)). Fifty-six patients had undergone previous cholecystectomy, and 7 other patients underwent concurrent cholecystectomy. Average follow-up was 12.5 months (range, 1.3 to 31 months). Absolute weight loss for all patients ranged from - 2.7 to 102.3 kg. Of the remaining patients, 3 underwent subsequent uneventful laparoscopic cholecystectomy for symptomatic cholelithiasis. No independent predictors for post-LAGB gallbladder disease were identified. CONCLUSION: Despite significant weight loss, few patients require cholecystectomy after LAGB. Routine preoperative ultrasonography, empiric cholecystectomy, and choleretic therapy are of questionable value in LAGB patients. Considering the magnitude of weight loss in our patients, empiric cholecystectomy for all bariatric procedures may merit further investigation.

Adolescent↗
PubMed2000

Food intake patterns and gallbladder disease in Mexican Americans.

OBJECTIVE: Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD. DESIGN: Cross-sectional. SUBJECTS: The study population included 4641 Mexican Americans aged 20-74 years who participated in the 1988-94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI). RESULTS: There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21-0.85) and fourth (POR = 0.53, 95%CI 0.28-1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile. CONCLUSIONS: These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet-disease associations. Nevertheless, methods to do so require further development and validation.

Adult↗
PubMed1995

Polymorphisms at the apoB, apoA-I, and cholesteryl ester transfer protein gene loci in patients with gallbladder disease.

Alterations in lipoprotein levels are reported to be related to an increased risk of gallstones. Plasma lipid metabolism is regulated by a number of proteins that are polymorphic in the population. The present research was designed to investigate the association between the polymorphisms of these proteins and the presence of various gallbladder diseases. Restriction fragment length polymorphisms (RFLPs) of apolipoprotein B (XbaI, EcoRI), apolipoprotein A-I (PstI, MspI), and cholesteryl ester transfer protein (CETP) (EcoNI, TaqIA, TaqIB) genes were examined in a series of 210 cholecystectomy patients operated on for symptomatic gallbladder disease and in 92 healthy controls. The patients were categorized into four groups according to the type of gallstones and the presence or absence of cholesterolosis. The distribution of CETP TaqIB polymorphism in the patients with cholesterol gallstones differed significantly from that in the controls, with the B1B1 jects (39.7%) (P = 0.036). The patients with both cholesterol and non-cholesterol stones had lower high density lipoprotein (HDL)-cholesterol levels than the control subjects. However, the most distinct difference was found in the gallstone patients with the B2B2 genotype (P = 0.006). The frequency of the X1X1 genotype of the apolipoprotein B XbaI polymorphism was markedly higher in the patients with acalculous cholesterolosis (48.9%) or cholesterolosis with stones (58.1%) than in the gallstone patients with cholesterol stones (27.2%) or with non-cholesterol stones (34.1%) (P = 0.002). The present data suggest that CETP gene polymorphism may ba associated with cholesterol gallstone disease, probably in combination with some additional factor that reduces the plasma HDL cholesterol concentration, especially in TaqIB B2B2 genotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Cholecystosonographic evaluation of the prevalence of gallbladder diseases. A university hospital experience.

Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gallbladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.

Adult↗
PubMed2001

Diagnostic accuracy of 99Tcm-HIDA with cholecystokinin and gallbladder ejection fraction in acalculous gallbladder disease.

The diagnostic accuracy and clinical impact of 99Tcm hepatic iminodiacetic acid (HIDA) imaging with cholecystokinin (CCK) was investigated in a prospective study of 359 patients over an 11 year period. All patients presented with right upper quadrant biliary type pain and had a normal ultrasound investigation prior to imaging. CCK was administered as a 3 min infusion at peak gallbladder uptake of HIDA. A gallbladder ejection fraction (GBEF) was used to quantify the gallbladder response to CCK. Two hundred and forty-four of 359 (68%) patients had an abnormal GBEF (< or = 35%). One hundred and thirty-four of 141 (95%) patients who underwent cholecystectomy had abnormal surgical/histological findings and/or relief of symptoms on long-term (mean 5.7 years) follow-up. Clinical follow-up, mean of 5.9 years, of the patients with GBEF > 35% showed 73/79 (92%) of them with little evidence of gallbladder disease. For a total 261 patients with mean clinical follow-up of 5.7 years the sensitivity of GBEF measurement is 95%, specificity is 92% and overall accuracy is 94%. It is concluded that 99Tcm-HIDA imaging, with a 3 min infusion of CCK, is a highly accurate technique and valuable in the diagnostic management of patients with suspected acalculous gallbladder disease.

Adult↗
PubMed1988

FM sonography in gallbladder disease: efficacy and comparison with conventional sonography.

A new type of ultrasound signal processing ("FM sonography") appears to be beneficial compared to conventional ultrasound ("AM sonography") in some applications (e.g., diffuse liver disease and prostatic carcinoma). Despite these possible advantages, it is doubtful FM sonography will be widely used unless it is at least as useful as conventional (AM) sonography in all common applications. Fifty-five patients with suspected gallbladder disease were independently evaluated with both AM and FM sonography. The two modalities were blindly and prospectively compared for accuracy in detecting gallstones and for image quality. No statistically significant difference was found between images produced by FM and conventional signal processing. FM had an accuracy of detecting gallstones of 98.1%, compared to 96.2% for AM. Overall, FM accuracy was 97.7%, while AM had an overall accuracy of 97.3%. Other useful sonographic signs were evaluated (gallbladder wall thickness, diameter of common duct). No AM/FM difference was noted. Our data suggest that FM-only imaging could be performed in patients with suspected gallbladder disease without loss of accuracy.

Cholelithiasis↗
PubMed2003

Gallstones, gallbladder disease, and pancreatitis: cross-sectional and 2-year data from the Swedish Obese Subjects (SOS) and SOS reference studies.

OBJECTIVES: Obesity and weight loss have been associated with gallstone disease. There is also an association between gallstones and pancreatitis. We investigated cross-sectional relationships between body mass index (BMI), body fat distribution, and prevalence of gallstones, gallbladder disease, and pancreatitis in men and women. Furthermore, 2-yr incidences of these disorders were examined in relation to changes in weight and body fat distribution after surgical and conventional obesity treatment. METHODS: Self-administered questionnaires were used to assess biliary and pancreatic disease. In the cross-sectional investigation, 6328 obese patients and 1135 randomly selected reference individuals were used. Longitudinally, 1422 operated and 1260 conventionally treated patients were examined. RESULTS: Obese subjects had significantly higher prevalence of cholelithiasis, cholecystitis, cholecystectomies, and pancreatitis as compared with the reference population. In women, BMI and waist-hip ratio (WHR) were independently related to an increased biliary disease prevalence. In men, only BMI was independently associated with biliary disease. Compared with conventional treatment, obesity surgery significantly increased the incidence of cholelithiasis, cholecystitis, and cholecystectomies in men. There was no incidence difference among women. In both genders, weight loss, but not change in WHR, was related to an increased incidence of biliary disease. CONCLUSIONS: This study showed an increased prevalence of gallstones, gallbladder disease, and pancreatitis in the obese. Biliary disease was related to BMI and WHR in women, but only to BMI in men. Weight loss, but not change in WHR, increased the risk of biliary disease in both genders.

Adult↗
PubMed1992

Right upper quadrant calcification: porcelain gallbladder disease.

Large solitary calcification in the right upper quadrant is rarely seen in the United States. It may indicate disease in the gallbladder, adrenal glands, kidneys, pancreas, lungs or chest wall. Disease processes associated with calcification in these organs include echinococcal cysts, calcified renal cysts, chest wall masses and degenerative cystic lesions of the pancreas and adrenal glands. However, if calcification is associated with porcelain gallbladder, the incidence of carcinoma is high. Treatment consists of cholecystectomy with a careful search for malignancy.

Calcinosis↗