title: [Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer].
abstract: OBJECTIVE
  It has been known that chronic trauma and inflammation of gallbladder (GB) mucosa by gallstones (GS) can induce epithelial dysplasia, carcinoma in situ, and invasive cancer. This study was designed to investigate the usefulness of cholecystectomy in patients with asymptomatic GS for the early diagnosis and removal of dysplasia or cancer.
  
  
  METHODS
  From January 2004 to July 2008, the clinical records of 703 cases with GS who underwent cholecystectomy at Korea University Guro Hospital were reviewed, and the prevalence of dysplasia and cancer was analyzed.
  
  
  RESULTS
  In symptomatic GS (542 cases) group, low grade dysplasia was found in 4 cases (0.74%) and high grade dysplasia in 1 case (0.18%). In asymptomatic GS (161 cases) group, low grade dysplasia was found in 4 cases (2.48%) and cancer in 2 cases (1.24%) (p=0.012 vs. symptomatic cases). Dysplasias in symptomatic GS group were not associated with polyps, but dysplasias and cancers in asymptomatic GS group were associated. Patients with asymptomatic GS and polyps were analyzed according to the size of polyps. In those (12 cases) with larger polyps (> or 1 cm), low grade dysplasia was found in 2 cases and cancer in 2 cases. And in those (12 cases) with smaller polyps (<1 cm), low grade dysplasia was found in 2 cases.
  
  
  CONCLUSIONS
  Extending indication of prophylactic cholecystectomy in patients with asymptomatic GS without polyp to prevent GB dysplasia or cancer beyond the existing indication does not seem to be justifiable in Korea. However, further studies are needed in patients with asymptomatic GS and polyp of any size.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Jung
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Seung Goun
authors.initials: SG
authors.lastname: Hong
authors.forename: Moon Kyung
authors.initials: MK
authors.lastname: Joo
authors.forename: Beom Jae
authors.initials: BJ
authors.lastname: Lee
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Jong Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Bak
authors.forename: Wan Bae
authors.initials: WB
authors.lastname: Kim
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Choi
mesh_terms: D000328:Adult; D002763:Cholecystectomy; D003937:Diagnosis, Differential; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000209:etiology; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D011230:Precancerous Conditions / Q000175:diagnosis*; D012189:Retrospective Studies