A SYSTEMATIC REVIEW AND META-ANALYSIS ON HISTOPATHOLOGICAL CHANGES IN GALLBLADDER IN EASTERN UTTAR PRADESH POPULATION
Main Article Content
Keywords
Gallbladder histopathology; Eastern Uttar Pradesh; systematic review; meta-analysis; cholecystitis; dysplasia; gallbladder carcinoma; PRISMA 2020 guidelines; parasitic infections; meta-regression analysis; carcinogenic progression; evidence-based clinical guidelines
Abstract
Background: Histopathological patterns of gallbladder diseases exhibit pronounced geographic variation although, available evidence is largely derived from isolated institutional studies, resulting in a fragmented understanding of disease patterns. This systematic review and meta-analysis were undertaken to estimate the pooled prevalence of gallbladder histopathological lesions in this population and to examine associations among inflammatory, premalignant, and malignant changes.
Methods: A systematic search of PubMed, Web of Science, MEDLINE, Google Scholar and major Indian biomedical journals was conducted for studies published between January 2000 and December 2024. The inclusion criteria included original research studies that provided quantitative histopathological measurement of specimens of Eastern Uttar Pradesh. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies by two independent reviewers. Pooled prevalence estimates with 95% confidence intervals (CI) were calculated using random-effects meta-analysis. Statistical heterogeneity was evaluated using the I² statistic, and to investigate potential sources of variability meta-regression analyses were performed.
Results: Out of 47 qualitative studies (n= 8,742 specimens) that were included, 35 studies consisting of 7,234 specimens were eligible as meta-analysers. The most common pathology was acute cholecystitis 58.4% (95% CI: 52.1–64.7%), then chronic cholecystitis 47.6% (95% CI: 41.3–54.0%), cholelithiasis-related changes 43.2% (95% CI: 36.8–49.6%). Intestinal metaplasia was seen in 22.7% (95% CI: 18.4–27.5%) dysplasia in 4.3% (95% CI: 2.8–6.4%), and gallbladder carcinoma in 2.8% (95% CI: 1.4–5.2%). The prevalence of parasitic infection was found to be 8.9% (95% CI: 5.7–13.5%) and it was much higher in rural areas than in urban area. Study-level analyses demonstrated strong associations between dysplasia and carcinoma (OR 18.4, 95% CI: 10.2–33.1), metaplasia and dysplasia (OR 4.2, 95% CI: 2.8–6.3), and cholelithiasis and carcinoma (OR 7.8, 95% CI: 5.2–11.7). Sensitivity analyses supported the stability of the pooled estimates.
Conclusions: Eastern Uttar Pradesh has a higher inflammatory disorder profile of the gallbladder. There is a clear progression of carcinogenic process- starting with chronic inflammation, progressing to metaplasia, dysplasia and finally malignancy. The high geographic inequality in the prevalence of parasitic infections highlights the need to implement region-specific efforts by the community in terms of health. These data provide evidence-based premises to the creation of the individualized clinical guidelines and preventive measures in the area.
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