Evaluation of the relationship between gallbladder polyps detected in cholecystectomy materials with colorectal polyp histopathology and localization

Aim: Colorectal cancer (CRC), the third most common cancer in the world and the second in terms of cancer-related mortality, is a major health problem. Most CRCs develop from adenomatous polyps over the years. Advanced histological features, polyp size, and polyp count are factors known to increase the risk of adenomatous polyps' transformation into a malignancy. Early detection and removal of colorectal adenoma may decrease colorectal cancer related mortality. Therefore, identification of risk factors associated with colorectal adenomas may facilitate screening and prevention of colorectal cancers. Gallbladder polyps are frequently diagnosed on routine abdominal ultrasonography and most of are non-neoplastic cholesterol polyps. The risk of gallbladder polyps has been linked to obesity, glucose intolerance, metabolic syndrome, and an increased body mass index, which are also common risk factors for colorectal adenoma. However, the relationship between gallbladder polyps and colorectal precancerous lesions remains elusive. In the present study aimed to evaluate the relationship between gallbladder polyps detected in cholecystectomy materials with the number, size, localization and histopathological features of colorectal polyps. Material and Method: In our study, the data of patients is retrospectively examined who underwent colonoscopy for different indications between 01.01.2012 and 10.03.2022 in the Baskent University Faculty of Medicine Gastroenterology Department Endoscopy Unit and underwent open or laparoscopic cholecystectomy procedure for different gallbladder diseases within the two years before or after colonoscopy. Demographic data, comorbidities, endoscopic and histopathological characteristics of colorectal polyps and pathological results of cholecystectomy materials were analyzed for 762 adult patients who included in our study. The characteristics features of colorectal polyps were compared between patients with or without gallbladder polyps. Results: The mean age of the patients were 56.49±8.77 (29-78) and 52.9% (n=403) of the patients were female. Gallbladder polyps were detected in 47% (n=358) and colorectal polyps were detected in 57% (n=434) of the patients. Among the patients with colorectal polyps, non-neoplastic polyp(s) were detected in 32.3% (n=140), at least one neoplastic (adenomatous and/or SSA/P) polyp in 64% (n=278), and colorectal carcinoma in 3.7% (n=16). Among the patients with gallbladder polyps, benign non-neoplastic polyps were detected in 96.1% (n=344), benign neoplastic polyps in 2.8% (n=10) and malignant polyps in 1.1% (n=4). Colorectal polyps of any histological type were found in 62% (n=222) of the patients with polyps in the gallbladder and in 52.4% (n=212) of the patients without them, and a statistically significant difference was found (p value=0.011). In addition, colorectal adenoma or invasive carcinoma were detected in 45.8% (n=164) of the patients with polyps in the gallbladder and in 32.2% (n=130) of the patients without polyps in the gallbladder (p value=0.005). The mean age of the patients with colorectal polyps with and without gallbladder polyps was 57.17±7.6 and 58.59±8.26, respectively (p value=0.025). The mean number of colorectal neoplastic polyps was 3.00±1.18 in patients with neoplastic polyps in the gallbladder and 2.20±1.29 in those without polyps in the gallbladder (p value=0.017). In those with neoplastic polyps in the gallbladder, there was a significant difference between both mean number of colorectal neoplastic polyps (3.00±1.18 vs. 2.16±1.41, p value=0.014) and multiple (≥2) of colorectal neoplastic polyps (90.9% vs. 56.2%, p value=0.027) compared to those with non-neoplastic polyps in the gallbladder. There was a significant difference in the presence of advanced adenomatous polyps in patients with adenomyomatous hyperplasia in the gallbladder compared to patients without gallbladder polyps (69% vs. 33.8%, p value=0.001). Conclusion: It is clear that our study makes important contributions to the literature as it is the first study to investigate the relationship between gallbladder polyps detected in cholecystectomy materials and colorectal polyp characteristics. In this study, the frequency of colorectal neoplastic polyps was found to be increased in patients with gallbladder polyps compared to those without gallbladder polyps, regardless of the histological type of gallbladder polyp. At the same time according to those who do not have polyps in the gallbladder significant results were also found in terms of the increased mean number of colorectal neoplastic polyps in patients with neoplastic polyps in the gallbladder and advanced histological changes in colorectal neoplastic polyps in patients with adenomyomatous hyperplasia. As a result, the relationship between gallbladder polyps and colorectal neoplastic polyps has been demonstrated, gallbladder polyps should also be considered in colorectal cancer screening programs. Key Words: gallbladder polyps, cholecystectomy materials, colorectal polyps, colorectal adenomas, risk factors