From the Guidelines
A calcified gallbladder polyp in a patient with primary sclerosing cholangitis (PSC) should be managed with cholecystectomy if the polyp is greater than or equal to 8 mm in size, due to the high risk of malignancy or dysplasia, as recommended by the EASL clinical practice guidelines 1. The management of calcified gallbladder polyps in patients with PSC requires careful consideration of the size and growth of the polyp, as well as the clinical status of the patient.
- The EASL guidelines suggest that cholecystectomy is recommended for patients with PSC and gallbladder polyps greater than or equal to 8 mm in size, due to the high risk of malignancy or dysplasia 1.
- The AGA clinical practice update also recommends that the decision to perform a cholecystectomy in PSC patients with a gallbladder polyp should be based on the size and growth of the polyp, as well as the clinical status of the patient 1.
- The British Society of Gastroenterology and UK-PSC guidelines note that gallbladder polyps are more often malignant in patients with PSC than in those without PSC, and malignancy may occur even in polyps <1 cm, highlighting the need for careful monitoring and consideration of cholecystectomy 1. In terms of treatment, laparoscopic cholecystectomy is the preferred surgical approach, with a typical recovery period of 1-2 weeks.
- No medications can dissolve or treat calcified polyps effectively, and the calcification process represents calcium deposition within the polyp tissue, which is why these lesions appear bright on imaging studies and are generally considered stable but warrant appropriate follow-up to ensure they remain benign. Overall, the management of calcified gallbladder polyps in patients with PSC requires a multidisciplinary approach, taking into account the size and growth of the polyp, as well as the clinical status of the patient, and considering the potential risks and benefits of cholecystectomy.
From the Research
Definition and Classification of Gallbladder Polyps
- A gallbladder polyp is an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen, with an estimated prevalence of 0.3-9.5% 2.
- Gallbladder polyps can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps), with pseudopolyps being most commonly cholesterol polyps, focal adenomyomatosis, and inflammatory polyps with no malignant potential 2.
Diagnosis and Surveillance of Gallbladder Polyps
- Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling gallbladder polyps 2.
- Alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated due to the difficulty in diagnosing gallbladder polyps before surgery 2.
Management of Gallbladder Polyps
- The current guidelines recommend cholecystectomy for gallbladder polyps ≥ 10 mm in size, as well as suboptimal sized gallbladder polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms 2.
- However, some studies suggest that observation may be a safe option for select populations, particularly those with limited life expectancy and significant comorbidities 3.
- The pathological result of many patients who undergo cholecystectomy due to gallbladder polyps is pseudopolyp or adenoma, with no carcinoma observed in some studies 4.
Calcified Gallbladder Polyp
- A calcified gallbladder polyp, also known as a porcelain gallbladder, is a condition where the gallbladder wall is calcified, which has been traditionally perceived as a strong association with gallbladder cancer 3.
- However, newer evidence suggests a much lesser association, and observation may be a viable option for select populations 3.
Controversies and Future Directions
- The management of gallbladder polyps is controversial, with some studies questioning the usefulness of current guidelines for management of suspected gallbladder polyps 5.
- Further studies are needed to determine the indication for surgery due to gallbladder polyps, particularly for those smaller than 10 mm 4, 6.