Congestive Cholecystopathy; A Frequent Sonographic Sign of Evolving Esophageal Varices in Cirrhotics

Background: Gallbladder wall congestion (congestive cholecystopathy) is frequent sonographic feature demonstrated in patients with chronic liver disease. Hypoalbuminemia is still considered as a most probable cause of gallbladder wall thickness in cirrhotics. Objective: To demonstrate and establish congestive cholecystopathy as a consistent sonographic sign of developing portal hypertension and its association with evolving esophageal varices in Child's class B (compensated) and C (decompensated) cirrhotic patients. Methodology: This cross-sectional study was conducted in Department of Radiology in collaboration with Department of Medicine, Omer Hospital, Lahore, between September 2009 and January 2011. We included 103 randomly sampled cirrhotic patients (67 men, 36 women; age range 38-79 years) who were clinically categorized into Class B and Class C liver disease through modified Child Pugh Classification. Upper gastrointestinal video endoscopy was performed for assessment of esophageal varices in all patients according to Japanese Research Society. Gall bladder targeted transabdominal ultrasound was performed on gray scale as well as color Doppler. Gallbladder wall thickness (4mm as a reference upper normal limit), pattern of wall thickening (striated or non-striated) and flow in wall were evaluated. Results: Out of 103 patients, 57 (55.3%) cases were of Child's B and 46 (44.7%) of Child's C class. There were 16, 32, 28 and 27 patients having F0, F1, F2 and F3 endoscopic grades of esophageal varices. On ultrasound, 76 out of 103 cirrhotics demonstrated wall thickness. Only 24 (31.5%) showed serum albumin levels below 35g/ L. Gall bladder wall thickness was more common in mild and moderate ascites. Striated pattern of wall thickening was documented in 11 cases (14.5%). On color Doppler evaluation, 23.6% patients with thick walled gall bladder demonstrated venous flow pattern in the vicinity of thick walls suggesting ectatic vessels in or along the gall bladder wall causing congestion. Conclusion: Congestive cholecystopathy is an important early sonographic sign of evolving esophageal varices and portal hypertension in liver cirrhosis. Recommendation is made for future studies to validate congestive cholecystopathy as a non-invasive screening parameter to evaluate evolving esophageal varices in the background of portal hypertension in liver cirrhosis.