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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 78-81

Determination of the gallbladder wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population


1 Department of Anatomy, Santosh Medical College and Hospital, Santosh Deemed to be University, Ghaziabad, Delhi-NCR, Uttar Pradesh, India
2 Department of Radiology, Government Medical College, Saharanpur, Uttar Pradesh, India

Date of Web Publication18-Nov-2019

Correspondence Address:
Dr. Durgesh Singh
Ph.D Scholar, Department of Anatomy, Santosh Medical College and Hospital, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ami.ami_33_19

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  Abstract 

Objective: The objective of the study was to determine the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis with the help of ultrasonography in North Indian population for the estimation of epidemiology. Aim: The aim was to estimate epidemiology of the GB wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population. Materials and Methods: This was a hospital-based case–control study. Patients with cholecystitis and cholelithiasis of age between 15 and 70 years of either sex were included in the study. The GB wall thickness was determined in the fasting state. A total of 50 samples, 36 cases (with diseased bladder) and 14 controls (with normal bladder) were included in the study. Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%) and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and overdistended (2.8%) were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: During ultrasonography, a higher degree of the GB wall thickness was found in patients with cholecystitis and cholelithiasis as compared to the control group.

Keywords: Carcinoma, cholecystitis, cholelithiasis, epidemiology, gallbladder wall thickness, ultrasonography


How to cite this article:
Singh V, Singh D, Tandon A, Yadav Y, Tiwari R. Determination of the gallbladder wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population. Acta Med Int 2019;6:78-81

How to cite this URL:
Singh V, Singh D, Tandon A, Yadav Y, Tiwari R. Determination of the gallbladder wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population. Acta Med Int [serial online] 2019 [cited 2019 Dec 14];6:78-81. Available from: http://www.actamedicainternational.com/text.asp?2019/6/2/78/264367


  Introduction Top


Gallbladder (GB) diseases mostly manifest as gallstones and GB cancer (GBC). Epidemiological studies should first find the burden of disease to identify the risk factors of this disease. Cholelithiasis (gallstones) is the frequently common form of GB disease.[1] It is documented that patients with symptomatic cholecystolithiasis will progress acute cholecystitis (ACC) more commonly than their asymptomatic counterparts; thereby, effectively increasing the risk of complications to five times higher (i.e., 20%).[2] The present study was designed to compare the GB wall thickness in cholelithiasis and cholecystitis patients with the help of ultrasonography in North Indian population.


  Materials and Methods Top


This was a hospital-based case–control study. Patients with cholecystitis and cholelithiasis of age between 15 and 70 years irrespective of gender were included in the study (cases). All patient's cases (36) and controls (14) were advised the night before that did not eat or drink. Contral groups (normal gallbladder) were collected when patients are having other abdominal diseases diagnosed by ultrasonography. The GB wall thickness was measured in fasting. A total of 50 samples of the GB are collected from the Department of Radiology, Santosh Medical College and Hospital, Santosh deemed to be University, Ghaziabad, Uttar Pradesh Delhi-NCR, after ethical clearance and obtaining consent from the patients, in this 36 cases and 14 controls were included in the study.

Gallbladder wall thickness measurement

All the ultrasound evaluations were examined by the single investigator both in cases and in controls. Real-time bi-dimensional and Doppler ultrasonic examinations were done using 3.5 MHz transducer (Logic P5 Pro, GE Healthcare) [Figure 1]. The GB was evaluated by the means of images found in both supine and the left lateral decubitus to evaluate the wall thickness, longest axis, distention, width, and depth to be measured [Figure 2] and [Figure 3].
Figure 1: Portable ultrasonography machine

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Figure 2: A 40 year patent showing Chronic calculus cholecystitis with the help of ultrasonography, arrows showings the gallbladder wall thickness

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Figure 3: In a 37 year patent the arrows showings anterior and posterior diameter of gallbladder with the help of ultrasonography (28Hz)

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Statistical analysis

The results are presented in frequencies, percentages, and mean ± standard deviation. The Chi-square test was used to find the associations of categorical variables between cases and controls. The unpaired t-test was used to compare the GB wall thickness between cases and controls. The odds ratio (OR) with its 95% confidence interval (CI) was calculated. The P < 0.05 was considered statistically significant. All the analysis was carried out using SPSS software 16.0 version (Chicago, Inc., IL, USA).


  Results Top


More than one-third of cases (38.9%) and 28.6% of controls were between the age group of 30 and 40 years. The average age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than half of both cases (63.9%) and controls (64.3%) were females. No significant (P > 0.05) difference was observed in age and gender between cases and controls showing comparability of the groups in terms of age and gender [Table 1]. Smoking was in 13.9% in cases and in 14.3% in controls. Alcohol habit was in 11.1% of cases and in 7.1% of controls [Table 2]. The GB wall thickness was significantly (P = 0.005) higher among cases (4.06 ± 2.28) than that of controls (2.22 ± 0.67) [Table 3]. GB wall thickness ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness <3 mm was 92% lower in cases compared to controls (OR = 0.08, 95% CI = 0.01–0.43, P = 0.001) [Table 4]. A full distention of the GB was among more than half in both cases (69.4%) and controls (57.1%). Partial distended was seen in 11.1% of cases and in 21.4% of controls. Contracted distention was observed in 8.3% of cases only [Table 5].
Table 1: Distribution of demographic profile of patients between cases and controls

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Table 2: Distribution of personal habit between cases and controls

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Table 3: Comparison of the mean gallbladder wall thickness between cases and controls

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Table 4: Comparison of the gallbladder wall thickness between cases and controls

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Table 5: Comparison of distention of the gallbladder between cases and controls

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  Discussion Top


Cancer of the gall bladder is uncommon; however, it is fifth frequently common gastrointestinal malignancy and is found in 1% to 3% of cholecystectomy specimens.[3] 2.5 new cases detected per 100,000 inhabitants/year. The mortality rate is high due to GB as most of the time, it is diagnosed at advanced stages of disease. This is due to the scarcity of symptoms.[4] Countries having a high incidence of GBC include Chile, Poland, India, and Japan. High incidence of GBC is being reported among North Indian women (21.5/100,000) and female native American Indians (14.5/100,000).[5] In the present study, 38.9% of cases and 28.6% of controls were between 30 and 40 years of age. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. Agrawal et al. reported that most of the patients were of the age group between 30 and 40 years with an average age of 37 years of acute and chronic cholecystitis patients.[6]

The percentage of females was higher than males in this study which was in consistent with the study by Agrawal et al. in which 70% of the acute and chronic cholecystitis patients were females.[6] Hasan et al.[7] reported that the youngest patient of this series was 28 years, and the oldest was of 79 years. Reported that female are more affected than male these ratio are 1:5 -- 1:2. In this study, the GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (OR = 0.08, 95%CI = 0.01–0.43, P = 0.001). Agrawal et al.[6] observed that the GB wall was >3 mm in 25.5% of patients with acute calculus cholecystitis and >3 mm in 24.5% of patients with chronic calculous cholecystitis. Engel et al.[8] reported that majority of healthy individuals (97%) had the gall bladder wall thickness of <2 mm. Hasan et al.[7] reported that there was a strong correlation between cholelithiasis and GBC, with gallstones found in nearly 80% of all cases. GBC can be as focal or diffuse asymmetric wall thickening in 20%–30% cases.[9]

According to several authors, the upper limit for the normal GB wall thickness is 3 mm. However, in patients with inappropriate fasting, the parietal thickness can be exceeded this limit. This is because of the organ's smooth muscle contraction.[4] GB contraction is recognized in resulting from long-standing chronic cholecystitis.[10] In this study, a full distention of the GB was among more than half in both cases (69.4%) and controls (57.1%). Partial distended was seen in 11.1% of cases and in 21.4% of controls. Contracted distention was observed in 8.3% of cases only.


  Conclusion Top


During ultrasonography, a higher degree of GB wall thickness was found in patients with cholecystitis and cholelithiasis as compared to the control group. The individual with the GB wall thickness of 7 mm and above is prone to have cancer; therefore, all such cases should be subjected to biopsy for histopathological examination to rule out the cancer GB for better prognosis.

Acknowledgments

We thankfully acknowledge the management and Department of Anatomy, Department of Radiology, Santosh Medical College and Hospital, Santosh deemed to be University, Ghaziabad, Uttar Pradesh, Delhi-NCR India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mills JC, Stappenbeck TS, Bunnett NW. Gastrointestinal disease. In: McPhee SJ, Hammer GD, editors. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6th ed., Vol. 38. New York: McGraw-Hill Medical; 2010. p. 33-41.  Back to cited text no. 1
    
2.
Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, et al. Acute calculous cholecystitis: Review of current best practices. World J Gastrointest Surg 2017;9:118-26.  Back to cited text no. 2
    
3.
Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH. Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 2002;40:1307-23, vi.  Back to cited text no. 3
    
4.
Barbosa AB, Souza LR, Pereira RS, Dippolito G. Gallbladder wall thickening at ultrasonography: How to interpret it? Radiol Bras 2011;44:381-7.  Back to cited text no. 4
    
5.
Miller G, Jarnagin WR. Gallbladder carcinoma. Eur J Surg Oncol 2008;34:306-12.  Back to cited text no. 5
    
6.
Agrawal S, Pathak P, Zaidi R. Role of gallbladder wall thickness in predicting laparoscopic operability prior to cholecystectomy: A retrospective analysis. Int Surg J 2018;5:1885-8.  Back to cited text no. 6
    
7.
Hasan MM, Laila SZ, Mamun MH. Incidence of gallbladder carcinoma in thick walled gallbladder in comparison with that of normal thickness – A study of 300 cases. J Bangladesh Coll Phys Surg 2016;34:193-8.  Back to cited text no. 7
    
8.
Engel JM, Deitch EA, Sikkema W. Gallbladder wall thickness: Sonographic accuracy and relation to disease. AJR Am J Roentgenol 1980;134:907-9.  Back to cited text no. 8
    
9.
Vijayakumar A, Vijayakumar A, Patil V, Mallikarjuna MN, Shivaswamy BS. Early diagnosis of gallbladder carcinoma: An algorithm approach. ISRN Radiol 2013;2013:239424.  Back to cited text no. 9
    
10.
Huang SM, Yao CC, Pan H, Hsiao KM, Yu JK, Lai TJ, et al. Pathophysiological significance of gallbladder volume changes in gallstone diseases. World J Gastroenterol 2010;16:4341-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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