title: Implications of gallbladder cholesterolosis and cholesterol polyps?
abstract: BACKGROUND
  The clinical significance of cholesterolosis has not been well established but there are some provocative, if not robust, studies of the role it may play in the pathophysiology of pancreatitis and biliary dyskinesia, as well as hypercholesterolemia. Our aim was to take advantage of a very large cholecystectomy (CCY) database to support or refute these potentially important reported associations.
  
  
  METHODS
  A retrospective review of 6868 patients who underwent CCY from 2001-2013 was performed. Comparisons were made using the student t-test for continuous and chi-square analysis for categorical, variables.
  
  
  RESULTS
  Among patients for whom the CCY was the primary operation, 1053 (18%) had cholesterolosis and 4596 did not. Compared to those without cholesterolosis, those with cholesterolosis were no more likely to have elevated cholesterol levels (P = 0.64) nor low gallbladder ejection fraction (P = 0.2). To evaluate cholesterolosis as a cause of pancreatitis, all patients with gallstones were eliminated, leaving 639 patients. Among these, not only was cholesterolosis not associated with more pancreatitis, but rather there was not a single patient with or without cholesterolosis who had pancreatitis.
  
  
  CONCLUSIONS
  Despite prior reports of associations between cholesterolosis and elevated serum cholesterol, depressed ejection fraction, and increased risk of pancreatitis, careful analysis of this current, larger data set does not support these associations. Any patient with stones or sludge, or with biliary dyskinesia, and appropriate symptoms, should be considered for CCY, with or without suspected cholesterolosis.
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Saif
authors.initials: S
authors.lastname: Dairi
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Demeusy
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Sill
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Shirali T
authors.initials: ST
authors.lastname: Patel
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Gopal C
authors.initials: GC
authors.lastname: Kowdley
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland. Electronic address: Steven.Cunningham@stagnes.org.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000368:Aged; D001657:Biliary Dyskinesia / Q000209:etiology*; D015415:Biomarkers / Q000378:metabolism; D002763:Cholecystectomy; D002784:Cholesterol / Q000378:metabolism*; D016208:Databases, Factual; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000378:metabolism; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011127:Polyps / Q000150:complications* / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002784:Cholesterol
keywords: Biliary dyskinesia; Cholesterolosis; Gallbladder dysfunction; Pancreatitis