Cholesterolosis. Incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy.
ABSTRACT To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment.
This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy.
The study group was comprised of 549 patients and out of which, 74 (13.4%) had cholesterolosis of the gallbladder. There were 59 (79.9%) female and 15 (20.1%) male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three (85.1%) cases were reported to have abnormally high fasting serum cholesterol levels (>=5.5 mmol/L), whereas 11 (14.9%) had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 (63.3%) patients while 27 (36.5%) subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 (95.9%) individuals, whereas 3 patients ended up with open cholecystectomy (conversion rate of 4.2%). There were no postoperative complications.
Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis.
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ABSTRACT: Only a few studies have evaluated the population-adjusted prevalence of gallbladder polyps (GBP). This study aimed to evaluate the changes in GBP prevalence and risk factors at a single health screening center in Korea from 2002 to 2012. Of 48,591 adults who underwent health screening between 2002 and 2012, 14,250 age- and gender-matched subjects were randomly selected to evaluate prevalence. Risk factors were analyzed between the GBP-positive and GBP-negative groups during 2002-2004 (Period A) and 2010-2012 (Period B). The annual prevalence of GBP over the 11-yr period was 5.4%. Annual prevalence increased from 3.8% in Period A to 7.1% in Period B. Male gender and obesity were independent risk factors for GBP in both periods. Hepatitis B virus surface antigen (HBsAg) positivity was a risk factor for GBP in Period A but not in Period B. The risk factors for GBP changed from HBsAg positivity to lipid profile abnormalities. Other variables including age, hypertension, diabetes, impaired fasting glucose, chronic hepatitis C virus infection, and liver function tests did not correlate with GBP. In conclusion, GBP prevalence is increasing and risk factors for GBP have changed in Korea. More attention should be paid to this issue in the future.Journal of Korean Medical Science 09/2014; 29(9):1247-52. · 1.25 Impact Factor
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ABSTRACT: Objective: Gallbladder stones are common in the Western world, and 70% to 80% of gallstones are cholesterol stones. This study investigates the effects of serum cholesterol, LDL, and HDL levels on gallstone cholesterol concentration. Methodology: The gallstones of 75 patients with cholelithiasis were examined using spectrophotometry. Results: High serum cholesterol and LDL levels were associated with high cholesterol stone rates (86.7% vs. 40.0%, P < 0.001; 75.0% vs. 48.9%, P < 0.05, respectively). Similarly, high serum cholesterol and LDL levels were correlated with high gallbladder stone cholesterol concentrations (63.6% vs. 44.4%, P < 0.001; 62.3% vs. 46.0%, P < 0.001, respectively). In contrast, low serum HDL levels do not seem to affect the occurrence of gallbladder cholesterol stones (60.0% vs. 58.3%, respectively, P > 0.05) or gallbladder stone cholesterol concentrations (50.8% vs. 52.4%, respectively, P > 0.05). Conclusion: The relationship between cholesterol, LDL, and HDL levels and cholesterol gallstone formation is multifactorial and complex and is also dependent on other individual properties.Pakistan Journal of Medical Sciences Online 09/2013; 29(1):187-90. · 0.10 Impact Factor
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ABSTRACT: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China. A total of 11,816 subjects who underwent health examinations in our hospital between August 2010 and February 2011 were analyzed retrospectively. Among them, there were 7174 men and 4642 women. PLG was diagnosed by the real-time ultrasonography. Those with the body mass index (BMI) ≥ 28 were considered to be obese. Blood biochemical indices were detected with the fully automatic biochemical analyzer and hepatitis B surface antigen (HBsAg) was tested by the automated enzyme immunoassay. The correlations between the prevalence of PLG and age, sex, BMI, serum cholesterol (T-Cho), triglycerides (TG), blood sugar, HBsAg, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), gallstone and fatty liver were investigated. After univariate analysis of 11 variables, stepwise logistic regression analysis was performed to explore the risk factors of PLG. There was a significant difference in sex, T-Cho, HBsAg, HDL-C, LDL-C and fatty liver between the PLG-positive group and the PLG-negative group (332/163 vs 6842/4479, P = 0.003; 22/473 vs 295/11,026, P =0.013; 92/403 vs 993/10,328, P = 0.001; 47/448 vs 332/10,989, P = 0.001; 32/463 vs 381/10,940, P = 0.001; 83/412 vs 3260/8061, P = 0.001). No significant difference was found in the age, BMI, TG, blood sugar and gallstone between the two groups (47.3 ± 26 vs 45.1 ± 33, P = 0.173; 59/436 vs 1097/10,224, P = 0.102; 52/443 vs 982/10,339, P = 0.158; 17/478 vs 295/11,026, P = 0.26; 24/471 vs 395/10,926, P = 0.109). Logistic regression analysis showed that the sex, HBsAg and HDL-C were independent risk factors for the development of PLG in a descending order of HDL-C > HBsAg > sex. In healthy people, the male gender, positive HBsAg, and low HDL-C confer higher risks of PLG development.World Journal of Gastroenterology 06/2012; 18(23):3015-9. · 2.43 Impact Factor
holesterolosis is an acquired histological
abnormality of the gallbladder epithelium,
consisting of an excessive accumulation of
cholesterol esters within
macrophages.1 This lesion of the gallbladder has
remained an enigma for over a century2 and it is still
important cause of biliary symptoms3 or just an
incidental histological finding.4 Cholesterolosis is
cholesterolosis is an
From the Department of Surgery, College of Medicine and King Khalid University Hospital, King Saud University 7805, Riyadh 11472, Kingdom of
Received 23rd December 2003. Accepted for publication in final form 6th April 2004.
Address correspondence and reprint request to: Dr. Gamal A. Khairy, Department of Surgery (37), Faculty of Medicine and King Khalid University
Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. Tel. +966 (1) 4671575. Fax. +966 (1) 4679493. E-mail: email@example.com
frequently encountered in the gallbladders exposed
to bile that is supersaturated with cholesterol, just as
cholesterol stones invariably form under the same
circumstances.5 The reported
cholesterolosis of the gallbladder varies from
2.7-28.6%,6,7 which is similar to that found in a large
autopsy series.8 Such a frequent occurrence of
cholesterolosis demands further evidence based on
clinical research to testify its clinical significance.
Gamal A. Khairy, FRCS, MS, Salman Y. Guraya, FRCS, Khalid R. Murshid, FRCS, FACS.
in the surgically removed gallbladders, its association
with serum cholesterol level and to review the role of
laparoscopic cholecystectomy in the treatment.
To report the incidence of cholesterolosis
patients who had consecutive cholecystectomies for
various gallbladder disorders, performed by 2 consultants
during a 5-year period from January 1997 through to
December 2002, in the College of Medicine and King
Khalid University Hospital, King Saud University,
Riyadh, Kingdom of Saudi Arabia. The clinical records
of those found to
histopathological examination were reviewed, and the
data were analyzed for their age, sex, fasting serum
cholesterol level and
This retrospective study included all
have cholesterolosis on
the final outcome of
patients and out of which, 74 (13.4%) had cholesterolosis
The study group was comprised of 549
of the gallbladder. There were 59 (79.9%) female and 15
(20.1%) male patients. Age ranged from 18-64-years with
a mean of 35.7-years. Sixty-three (85.1%) cases were
reported to have abnormally high fasting serum
cholesterol levels (≥5.5 mmol/L), whereas 11 (14.9%)
had normal serum cholesterol level. Cholesterolosis with
coexistent gallstones was documented in 47 (63.3%)
patients while 27 (36.5%) subjects showed acalculous
cholesterolosis. Laparoscopic cholecystectomy was
performed in 71 (95.9%) individuals, whereas 3 patients
ended up with open cholecystectomy (conversion rate of
4.2%). There were no postoperative complications.
distinct pathologic entity and carries a positive
correlation with high
Laparoscopic cholecystectomy is effective, safe and a
feasible treatment modality for cholesterolosis.
Cholesterolosis of the gallbladder is a
serum cholesterol level.
Saudi Med J 2004; Vol. 25 (9): 1226-1228
Cholesterolosis ... Khairy et al
www.smj.org.saSaudi Med J 2004; Vol. 25 (9) 1227
* Procedure started as laparoscopic cholecystectomy
Table 1 - Characteristics of patients with cholesterolosis (n=74)
High serum cholesterol
Normal serum cholesterol
esterified cholesterol in the gallbladder mucosa.9
More recent data has unequivocally predicted that
venous and lymphatic stasis may be the etiological
factors causing disturbance in secretory or
absorptive functions of the gallbladder epithelium.10
Lamont and Carey11 have suggested that the
absorption of cholesterol esters and triglycerides
from the gallbladder lumen leads to muscle
dysfunction: G proteins are not activated when
cholecystokinin binds to its receptors on smooth
muscle cells of a lithogenic gallbladder.
The published literature has revealed 0-28.6%
incidence of cholesterolosis of the gallbladder in
various studies.12,13 However, Kmiot et al14 have
documented a much higher incidence of 62% in
their study of 55 patients. No obvious reason could
be detected for such a profound discrepancy from
the reported figures. Our study showed 13.4%
incidence, which is in accordance with the
published reports. The
cholesterolosis is analogous to that of cholesterol
gallstone disease: cholesterolosis is uncommon in
children and shows a marked predilection for
women up to 60 years.15 Similarly, the present series
reported a female:male ratio of 3.9:1 and a mean
age of 35.7 years, which further substantiates this
previously held observation. Nahum et al13 have
reported 90 patients with cholesterolosis, in their
retrospective study of 636 cases. In the same series,
53 (58.8%) individuals with cholesterolosis were
found to have concomitant gallstones, whereas 37
(41.2%) cases had acalculous cholesterolosis. Our
study demonstrated 63.4% calculous and 36.6%
acalculous cholesterolosis. These figures reaffirm
the observation that although gallstone disease and
cholesterolosis share the same etiological pathway,
the 2 lesions occur independently and do not always
Our study presents the incidence of cholesterolosis
in the surgically excised
hypercholesterolemia. The role of laparoscopic
cholecystectomy (LC) in the management of
cholesterolosis is discussed.
conducted at the College of Medicine and King
Khalid University Hospital, King Saud University,
Riyadh, Kingdom of Saudi Arabia. The medical
records of all patients who underwent consecutive
cholecystectomies for gallbladder stones and other
lesions, from January 1997 to December 2002, were
reviewed. The case reports of the patients
documented to have histological evidence of
cholesterolosis of the gallbladder were further
examined. The parameters considered were patient’s
age, sex, fasting serum cholesterol level and the
outcome of cholecystectomy. The diagnosis of
cholesterolosis of the gallbladder was established on
macroscopic and microscopic criteria.1 On naked
eye examination, the gall bladder mucosa shows
characteristically pale yellow linear streaks running
longitudinally (strawberry gallbladder). The most
striking microscopic feature is the abundance of
macrophages stuffed with lipid droplets giving rise
to foam cells. Serum cholesterol level of ≥5.5
mmol/L was considered abnormally high.
This retrospective review was
in this series, 433 (78.9%) were female and 116
(21.1%) male. The age ranged from 18 to 64 years
with a mean of 35.7 years. Out of 549 patients, 74
(13.4%) were found to have cholesterolosis of the
gallbladder. The characteristics of the patients with
cholesterolosis are shown in Table 1. Laparoscopic
cholecystectomy was performed in 71 (95.9%)
cases, while open cholecystectomy (OC) was
carried out in 3 (4.1%) individuals (conversion rate
of 4.2%). Open cholecystectomy was undertaken in
2 patients due to obscure anatomy in the Calot’s
triangle and due to uncontrolled bleeding in one
patient. No postoperative
coexistent gallstones, whereas 27 (36.6%) were
reported to have acalculous
Sixty-three (85.1%) patients with cholesterolosis
showed abnormally high serum cholesterol levels,
while 11 (14.9%) had normal serum cholesterol
A total of 549 patients were included
is a form of local disturbance of lipid metabolism.
The possible pathogenic mechanism that triggers the
development of cholesterolosis is the stimulation of
cholesterol. This leads to increased deposition of
Cholesterolosis of the gallbladder
by the biliary
Cholesterolosis ... Khairy et al
1228 Saudi Med J 2004; Vol. 25 (9) www.smj.org.sa
coexist in the same individual. Cholesterolosis of
the gallbladder is a rare manifestation of persistently
raised serum cholesterol level, more common being
atherosclerosis of the coronary and carotid vessels.
Hypercholesterolemia has an established correlation
with the pathogenesis of cholesterolosis.16 The
present study elucidated this finding and revealed
85.1% incidence of coexistent cholesterolosis and
Since the introduction of LC in 1989, this
procedure is being offered to almost all the patients
with different gallbladder disorders.17 High safety
profile, early discharge from the hospital, rapid
return to normal activity and cosmesis are the
outright benefits of LC.18,19 In the present study, 71
(95.9%) patients with cholesterolosis of the
gallbladder had successful treatment with LC with a
conversion rate to OC being 4.1%. The published
conversion rate20-22 of LC to OC ranges from 2.7 to
13.9%, where the indications for LC encompassed
almost all gallbladder affections. Our conversion
rate is similar to the reported results and thus,
further elaborates the established efficacy of LC in
the surgical treatment of cholesterolosis.
In conclusion, the incidence of cholesterolosis of
the surgically removed gallbladders is significant.
Hypercholesterolemia and cholesterolosis invariably
coexist in the same individual and LC is the
recommended surgical therapy for cholesterolosis of
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