담낭 용종과 담석이 동반된 경우 수술, Gallbladder polyps along with gallstones, cholecystectomy

UpToDate는 2017.07월 개정된 내용이고 Sleisenger and Fordtran's Gastrointestinal and Liver disease는 2016 개정된 내용입니다. 모두 담낭 용종과 담석이 동반된 경우에는 담낭절제술을 시행해야(should)한다고 되어 있습니다. 2017년 Joing guideline에서는 담석을 위험 인자로 가이드라인에 포함시키기에는 증거가 불충분하다고 되어 있습니다. 최근 이에 대한 내용의 강의가 있어 textbook과 저널을 찾아 보았습니다.

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담낭 용종(gallbladder polyps)과 담석이 동반된 환자는 용종의 크기와 증상 유무와 상관 없이 담낭절제술을 받아야 합니다. 그 이유는 담석이 담낭 용종이 있는 환자에서 담낭암의 위험 인자이기 때문입니다.

Polyps along with gallstones or primary sclerosing cholangitis — Patients who have gallbladder polyps and concomitant gallstones should undergo cholecystectomy regardless of the polyp size or the presence of symptoms, since gallstones are a risk factor for gallbladder cancer in patients with gallbladder polyps REF. UpToDate 2019.06.07

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Biliary pain이 있는 환자, 담낭 용종과 담석의 초음파 증거가 있는 환자는 elective cholecystectomy를 받아야 합니다.

Patients with biliary pain and US evidence of both polyps and stones in the gallbladder should undergo elective cholecystectomy. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Tenth Edition

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Some authors have suggested that the presence of gallstones may be a risk factor for malignancy in gallbladder polyps. Aldouri et al. For example, demonstrated that the presence of gallstones was an independent risk factor but with borderline significance. Park et al., however, found that gallstones were not an independent risk factor on multivariate analysis. Again the evidence level in this area is low. The group concluded that there was insufficient evidence to include gallstones as a strong risk factor in the guidelines, but note that some of these patients are likely to be symptomatic and as such will undergo cholecystectomy anyway. Management and follow-up of gallbladder polyps Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE)

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