Endoscopic ultrasonography in diseases of the gallbladder

Symptomatic cholelithiasis and functional disorders of the biliary tract

Symptomatic cholelithiasis and functional disorders of the biliary tract present with similar signs and symptoms. The functional disorders of the biliary tract include functional gallbladder disorder, dyskinesia, and the sphincter of Oddi disorders. Although the diagnosis and treatment of symptomatic cholelithiasis are relatively straightforward, the diagnosis and treatment of functional disorders can be much more challenging. Many aspects of the diagnosis and treatment of functional disorders are in need of further study. This article discusses uncomplicated gallstone disease and the functional disorders of the biliary tract to emphasize and update the essential components of diagnosis and management.

Evidence-based current surgical practice: calculous gallbladder disease

BACKGROUND

Gallbladder disease is common and, if managed incorrectly, can lead to high rates of morbidity, mortality, and extraneous costs. The most common complications of gallstones include biliary colic, acute cholecystitis, common bile duct stones, and gallstone pancreatitis. Ultrasound is the initial imaging modality of choice. Additional diagnostic and therapeutic studies including computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are not routinely required but may play a role in specific situations.

DISCUSSION

Biliary colic and acute cholecystitis are best treated with early laparoscopic cholecystectomy. Patients with common bile duct stones should be managed with cholecystectomy, either after or concurrent with endoscopic or surgical relief of obstruction and clearance of stones from the bile duct. Mild gallstone pancreatitis should be treated with cholecystectomy during the initial hospitalization to prevent recurrence. Emerging techniques for cholecystectomy include single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery. Early results in highly selected patients demonstrate the safety of these techniques. The management of complications of the gallbladder should be timely and evidence-based, and choice of procedures, particularly for common bile duct stones, is largely influenced by facility and surgeon factors.

Papel de las imágenes en el enfoque diagnóstico del paciente con ictericia

La  ictericia es un signo que describe  la coloración amarillenta de piel, escleras y mucosas por acumulación de bilirrubina. Es causa  frecuente de consulta en  los servicios de urgencias y de  consulta externa; de hecho, es muy  frecuente en el  periodo neonatal. La ictericia no es una entidad aislada sino  es el reflejo de una enfermedad específica. Por tal motivo,  luego  de  una  adecuada  evaluación  clínica  y  teniendo  los  paraclínicos pertinentes, se inicia el estudio del cuadro por  imágenes  con  una  ecografía;  según  los  hallazgos  se  continua  el  estudio  tomografía  abdominal  con  medio  de  contraste para evaluar el tracto biliar, resonancia magnética  u otros métodos no invasivos según el estado del paciente y  su  disponibilidad.  Dependiendo  de  los  resultados  es  necesario continuar con colangiopancreatografía retrógrada endoscópica como método diagnóstico, terapéutico o ambos.  

Correlation between clinicopathological and ultrasonic diagnosis of small protuberant lesions of the gallbladder

AIM: To explore the correlation between clinicopathological and ultrasonic diagnosis of small protuberant lesions of the gallbladder (SPLG).

METHODS: Seven hundred and fifty-three patients who were diagnosed with SPLG by abdominal color Doppler ultrasonography and pathological examination were included in our study. The correlation between clinicopathological characteristics and ultrasonic imaging characteristics of SPLG was retrospectively analyzed.

RESULTS: For all the 753 patients with SPLG, ultrasonic diagnosis had a sensitivity of 98.26%, a specificity of 84.42%, an accuracy of 89.77%, a positive predictive value of 89.77%, and a negative predictive value of 89.61%. For the patients with cholesterol polyps, the positive predictive value of ultrasonic diagnosis was more than 92.72%. Between SPLG patients with cholecystitis and gallstones, a significant difference was found in clinicopathological characteristics (t = 3.417, P < 0.05). Of all the SPLG patients, 92.30% (695/753) had SPLG with a diameter ≤10 mm, of which 99.14% (689/695) had a benign disease and 0.86% (6/695) had a malignant disease, and 7.70% (58/753) had SPLG with a diameter >10 mm, of which 56.90% (33/58) had a benign disease and 43.10% (25/58) had a malignant disease. A significant difference was noted in the diameter of benign and malignant polyps (t = 15.381, P < 0.01).

CONCLUSION: The positive predictive value of ultrasonic diagnosis of cholesterol polyps is more than 90%. Ultrasonic diagnosis has high clinical value and is the first choice for the diagnosis of SPLG.