title: Metaplastic changes in chronic cholecystitis: implications for early diagnosis and surgical intervention to prevent the gallbladder metaplasia-dysplasia-carcinoma sequence.
abstract: BACKGROUND
  Metaplastic features of the gallbladder epithelium are considered to be the precursors of gallbladder cancer. Considering the possible role of chronic inflammatory changes in the development of these lesions and the rationale for performing an early prophylactic cholecystectomy, we performed a retrospective study to assess the prevalence of gallbladder metaplasia in patients who underwent cholecystectomy due to underlying cholelithiasis.
  
  
  METHODS
  We reviewed the routine histopathology reports of 86 patients with chronic cholecystitis, who underwent elective cholecystectomy, to assess the prevalence of gallbladder metaplasia in the course of chronic cholecystitis. We further attempted to evaluate the existence of any correlations between the presence of the gallbladder metaplasia and the type of lithiasis, as well as the gallbladder wall thickness.
  
  
  RESULTS
  The overall prevalence of metaplastic features in the resected specimens was 25.6%. Dysplastic changes were more frequent in gallbladder specimens with concurrent metaplasia. Moreover, in presence of metaplastic changes, we observed an increase of the average gallbladder wall thickness. Finally, metaplastic and dysplastic changes were associated with the presence of micro-lithiasis rather than macro-lithiasis.
  
  
  CONCLUSIONS
  Gallbladder metaplastic changes appear to be more frequent in cases of micro-lithiasis and seem to be associated with a chronic thickening of the gallbladder wall. Taking into account the usually sub-clinical course of this group of patients, when compared to patients with macro-lithiasis, further studies are needed to evaluate a possible role of prophylactic cholecystectomy in this population to prevent the long term evolution of these early changes to cancerous lesions.
authors.affiliation: Department of General Surgery, 401 General Army Hospital of Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Seretis
authors.affiliation: Department of General Surgery, 401 General Army Hospital of Athens, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Lagoudianakis
authors.affiliation: Department of General Surgery, 401 General Army Hospital of Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Gemenetzis
authors.affiliation: Medical School of Patras, Greece.
authors.forename: Fotios
authors.initials: F
authors.lastname: Seretis
authors.affiliation: Department of Internal Medicine, Argos District Hospital, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Pappas
authors.affiliation: Department of General Surgery, 401 General Army Hospital of Athens, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Gourgiotis
keywords: Cancer; Cholecystectomy; Gallbladder; Metaplasia