14800-DvRappard

156 Chapter 9 Based on a previous report 15 and the present findings, we consider MLD a disease associated with an increased risk of gallbladder carcinoma. Consistent with this, we followed current guidelines for patients with increased risk of malignant transformation of gallbladder polyps 29 and performed cholecystectomy for polyps exceeding 5 mm in HSCT-treated patients and also in untreated patients in good clinical condition. Patients with thickened gallbladder wall in whom ultrasound cannot rule out the presence of polyps should also be considered candidates for cholecystectomy, as radiologic follow- up is predicted to be difficult. In patients with advanced neurologic involvement, decision to operate or closely follow abnormal findings is more challenging and should be made on an individual basis, also taking into account the reduction in quality of life due to symptomatic gallbladder involvement. We propose adding ultrasound screening for gallbladder abnormalities to the standard clinical care of patients with MLD. Ultrasound is noninvasive and inexpensive and allows early detection of changes predisposing to gallbladder carcinoma, although one should bear in mind that it may miss polyps in patients with thickened wall or collapsed gallbladder. Patients at risk, as defined by polyps ≥ 5mm, (severe) thickening of the gallbladder wall or with symptomatic gallbladder involvement can be treated with laparoscopic cholecystectomy, a relatively low risk procedure, in order to improve quality of life and avoid untimely death from a preventable cause.