Likelihood of malignancy in gallbladder polyps and outcomes following cholecystectomy in primary sclerosing cholangitis.
OBJECTIVE
Patients with primary sclerosing cholangitis (PSC) have an increased risk for gallbladder cancer. We aimed to define the postoperative outcomes in PSC patients after cholecystectomy and determine if size of a gallbladder lesion on imaging predicts the presence of neoplasia.


METHODS
We conducted a retrospective review of patients with PSC who underwent cholecystectomy at Mayo Clinic between 1 January 1995 and 31 December 2008. Patients with a prior history of a liver transplant or cholangiocarcinoma were excluded.


RESULTS
A total of 57 patients were included in our primary analysis during the early postoperative period. The most common indication for undergoing a cholecystectomy was the presence of a gallbladder polyp or mass. The sensitivity and specificity of a gallbladder lesion of 0.80 cm and the presence of gallbladder neoplasia was 100% (95% confidence interval (CI) 77-100%) and 70% (95% CI 35-93%), respectively. Of the patients, 23 (40%) had an early postoperative complication. The Child-Pugh score was the only predictor of postoperative outcomes in the multivariate model (odds ratio 1.78, 95% CI 1.11-3.12, P=0.02).


CONCLUSIONS
Cholecystectomy in patients with PSC is associated with a high morbidity. Gallbladder polyps <0.80 cm are unlikely to be malignant and observation of these small polyps should be considered. A higher Child-Pugh score was associated with early postoperative complications.
Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
John E
JE
Eaton
Erin W
EW
Thackeray
Keith D
KD
Lindor
D019540:Area Under Curve; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005705:Gallbladder Diseases / Q000473:pathology* / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome