Porcelain Gallbladder: Is Observation A Safe Option?
*Haley DesJardins, *Lindsay Duy, *Christopher Scheirey, Thomas Schnelldorfer
Lahey Hospital & Medical Center, Burlington, MA
Objective: Management of gallbladder wall calcifications has been under controversy for many decades. While the traditionally perceived strong association with gallbladder cancer mandated prophylactic cholecystectomy, newer evidence suggests a much lesser association and may indicate an observational approach.
Design: A retrospective cohort study of 113 patients with gallbladder wall calcifications diagnosed between 2004 and 2016 at a single institution. Radiographic re-review identified patients with definitive (n=70) and highly probable (n=43) gallbladder wall classifications. Patients were categorized according to their designated treatment plan.
Setting: Academic tertiary care center.
Patients: Patients with gallbladder wall calcifications.
Main Outcome Measure: Rate of gallbladder malignancy.
Results: Of 113 patients, 36% underwent radiographic imaging for abdominal pain. In the observation group (n=90), delayed cholecystectomy for gallbladder-related symptoms was necessary in four patients (4%). None of the patients in this group were diagnosed with a gallbladder malignancy during an average 3.2+/-3.2 year follow-up. In the operative group (n=23), perioperative complications occurred in 13%. Gallbladder malignancy was found in 2 patients; all with a gallbladder mass seen on initial radiographic exam. In group comparison, while patients in the observation group were older (73 versus 65 years, p=0.003), the rate of adverse events was similar (4% versus 13%; p=0.15) with an overall low risk for potentially life-threatening complications with observation.
Conclusions: For patients with gallbladder wall calcifications, there appears to be no significant difference in adverse events, including development of gallbladder malignancy, with an observational versus operative approach. While there is a clear need for intervention in the presence of radiographic findings suggestive of malignancy
or in the presence of symptoms, the need for prophylactic cholecystectomy for asymptomatic patients remains questionable.
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