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Background: The American Association for the Study of Liver Disease (AASLD) guideline recommends cholecystectomy for GB polyps of any size in patients with PSC without strong supporting evidence.
Objective: Evaluate the predictors of malignancy and outcomes of PSC patients with GB polyps.
Methods: We identified 86 patients with PSC and GB polyps at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009 using a computerized record system. Twenty-six patients were excluded due to indefinite diagnosis or inadequate follow up data.
Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as having GB polyps with a median age of 49.8 years; 67% were male. The median follow up from the diagnosis of GB polyps to the last follow-up was 3.5 years. Thirty-one patients (52%) subsequently underwent cholecystectomy and eight of 31 patients (25.8%) developed malignant GB lesions. Low-grade dysplasia of the GB was seen in two (6.4%). Twenty-nine patients without cholecystectomy had a median follow up of 4.8 years and none of them developed a malignant GB lesion during follow-up. By multivariable logistic analysis, the size of GB polyps at baseline was associated with malignant GB lesions or GB dysplasia (OR = 7.0; 95%CI 2.0-25.1).
Conclusions: One third of GB polyps in patients with PSC who underwent cholecystectomy become malignant or developed dysplasia. A GB polyp at first diagnosis of at least 1 cm in size was a good predictor for malignant lesions of GB or GB dysplasia. In PSC patients with comorbidities who had GB polyp size at first diagnosis less than 1 cm, careful monitoring of the progression of GB polyp size over time with periodical assessment by ultrasound may be an option.
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’s. Id . at 149. If there was an heir and the wife died first, the husband would keep the land for his lifetime only, after which the land would go to the wife’s heir rather than the husband’s in order to keep the land in the wife’s family bloodline. Id . The fourteenth century Book of Chertsey Abbey in Surrey alone gives several examples. Hugh atte Clauwe of Thorpe appears as Hugh le Keach after his marriage to Alice le Keach. R EANEY , supra note 142, at 85, citing E LSIE t OMS , c OURT B OOK OF c HERTSEY A BBEY xxxviii. John atte Hethe of Cobham married