From the Guidelines
Gallbladder adenomyomatosis is a benign condition that typically requires no specific treatment, but for symptomatic cases, surgical removal of the gallbladder (cholecystectomy) may be recommended, as supported by the most recent guidelines 1.
Overview of Gallbladder Adenomyomatosis
Gallbladder adenomyomatosis is characterized by an overgrowth of the gallbladder wall muscle (hyperplasia) and an outpouching of the inner lining (mucosa) into the muscle layer, forming small sac-like structures called Rokitansky-Aschoff sinuses. This condition is usually asymptomatic and discovered incidentally during imaging for other reasons.
Treatment Options
- For asymptomatic cases, no treatment is necessary.
- For symptomatic cases, such as right upper quadrant pain similar to gallstones, treatment options include:
- Pain medications like acetaminophen or NSAIDs for mild discomfort.
- Surgical removal of the gallbladder (cholecystectomy) for persistent or severe symptoms, as recommended by recent guidelines 1, which prioritize laparoscopic cholecystectomy as the first-line treatment for patients with acute calculus cholecystitis.
Monitoring and Prevention
While adenomyomatosis itself is not considered pre-cancerous, regular monitoring with ultrasound every 6-12 months may be advised for diffuse or segmental forms to track any changes. The exact cause remains unknown, but theories suggest it may result from increased pressure within the gallbladder due to functional obstruction of bile flow, leading to muscle thickening and mucosal herniation as a response to this chronic pressure.
Considerations for Common Bile Duct Stones (CBDS)
For patients with gallbladder stones and stones in the CBD, there is a risk of cholecystitis and/or stone migration following duct clearance. Recent guidelines suggest that clearance of bile duct stones should be considered the standard of care, and patients should be referred to specialist centers for consideration of surgery or advanced endoscopic therapy if stones cannot be removed using standard stone extraction techniques 1.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
SPECIAL NOTE Gallbladder stone dissolution with Ursodiol Capsules USP, 300 mg treatment requires months of therapy. Complete dissolution does not occur in all patients and recurrence of stones within 5 years has been observed in up to 50% of patients who do dissolve their stones on bile acid therapy. Patients should be carefully selected for therapy with ursodiol, and alternative therapies should be considered. The FDA drug label does not answer the question about gallbladder adenomymatosis.
From the Research
Definition and Characteristics of Gallbladder Adenomyomatosis
- Gallbladder adenomyomatosis is a benign acquired gallbladder disease characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis, forming Rokitansky-Aschoff sinuses 2, 3.
- It can mimic cancer on radiological findings, leading to a diagnostic dilemma, and its management and prognosis are entirely different from those of gallbladder cancer 2, 4.
- There are three forms of adenomyomatosis: segmental, fundal, and diffuse, with a prevalence of 1% to 9% in cholecystectomy specimens and a balanced sex ratio 3.
Diagnosis of Gallbladder Adenomyomatosis
- The diagnosis of gallbladder adenomyomatosis is based mainly on ultrasound (US), which identifies intra-parietal pseudo-cystic images and "comet tail" artifacts 2, 5, 3.
- MRI with MRI cholangiography sequences is the reference examination, showing characteristic "pearl necklace" images 5, 3.
- High-resolution ultrasound is the most efficient radiological examination for diagnosing gallbladder adenomyomatosis 2.
- Histologic examination can also confirm the diagnosis when cholecystectomy is performed 2, 3.
Management of Gallbladder Adenomyomatosis
- Symptomatic adenomyomatosis is an indication for cholecystectomy, which results in complete disappearance of symptoms 2, 6, 3.
- Asymptomatic adenomyomatosis is not an indication for surgery, but the radiological diagnosis must be beyond any doubt 6, 3.
- If there is any diagnostic doubt about the possibility of gallbladder cancer, a cholecystectomy is justified 2, 6, 3.
- Laparoscopic cholecystectomy is the gold standard for symptomatic gallbladder adenomyomatosis or radiological suspicion of gallbladder cancer 2, 6.