What is the management for gallbladder (cholecystic) polyps?

From the Guidelines

For gallbladder polyps, surgical consultation is recommended for polyps of 15 mm or larger, and follow-up US at 6,12, and 24 months is recommended for polyps measuring 10–14 mm, as stated by the Society of Radiologists in Ultrasound consensus conference recommendations 1.

Key Considerations

• The management of gallbladder polyps depends on their size and characteristics, with a focus on minimizing the risk of malignancy or dysplasia.
• Small polyps less than 10mm generally require monitoring with ultrasound every 6-12 months to check for growth, as rapid sustained growth is conceptually concerning and may indicate an increased risk of malignancy 1.
• The SRU consensus conference committee agreed that growth of up to 3 mm may be part of the natural history of nonmalignant gallbladder polyps, while growth of 4 mm or more within 1 year constitutes rapid growth 1.

Special Considerations

• In people with primary sclerosing cholangitis (PSC), cholecystectomy is recommended for gallbladder polyps greater or equal to 8 mm in size and smaller polyps growing in size, due to the high risk of malignancy or dysplasia 1.
• The risk of malignant development in a polyp increases with size, and polyps over 10 mm are associated with a higher risk of gallbladder carcinoma (GBC) 1.

Lifestyle Recommendations

• While waiting for follow-up or surgery, maintaining a healthy lifestyle with a low-fat diet may help reduce gallbladder irritation.
• Avoiding fried foods, processed meats, and high-fat dairy products, as well as regular exercise and maintaining a healthy weight, may help manage symptoms.

Importance of Consultation

• Always consult with a healthcare provider for personalized advice based on your specific polyp characteristics and medical history, as the management of gallbladder polyps requires careful consideration of individual risk factors and circumstances.

From the Research

Diagnosis of Gallbladder Polyps

• The primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound 2
• Alternative imaging modalities, such as contrast-enhanced and endoscopic ultrasound, may be useful to aid decision-making in difficult cases 2

Treatment of Gallbladder Polyps

• Cholecystectomy is recommended in patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery 2, 3, 4, 5, 6
• Cholecystectomy is suggested for patients with a polypoid lesion and symptoms potentially attributable to the gallbladder if no alternative cause for the patient's symptoms is demonstrated and the patient is fit for, and accepts, surgery 2
• If the patient has a 6-9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery 2

Follow-up of Gallbladder Polyps

• If the patient has either no risk factors for malignancy and a gallbladder polypoid lesion of 6-9 mm, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year and 2 years 2
• If the patient has no risk factors for malignancy, and a gallbladder polypoid lesion of 5 mm or less, follow-up is not required 2
• If during follow-up the gallbladder polypoid lesion grows to 10 mm, then cholecystectomy is advised 2
• If during follow-up the gallbladder polypoid lesion disappears, then monitoring can be discontinued 2