From the Guidelines
Large gallbladder polyps, particularly those greater than 10 mm, can cause pain due to potential obstruction, inflammation, or irritation of the gallbladder wall. The pain associated with large gallbladder polyps typically manifests as discomfort in the right upper quadrant of the abdomen and may be accompanied by symptoms such as nausea, vomiting, or indigestion 1. These symptoms can occur because larger polyps can obstruct the flow of bile or cause inflammation, similar to the symptoms experienced with gallstones. Some patients might experience pain after eating fatty meals, as the gallbladder contracts against the polyp during digestion.
Key Considerations
- The size of the polyp is a significant factor in determining the risk of neoplasia and potential symptoms, with polyps larger than 10 mm carrying a higher risk 1.
- A recent study found that neoplastic polyps were significantly larger than nonneoplastic polyps, with a size larger than 15 mm being an independent risk factor for neoplastic polypoid gallbladder lesions 1.
- The Society of Radiologists in Ultrasound consensus conference recommendations suggest surgical consultation for polyps of 15 mm or greater, and consideration of surgical consultation for polyps measuring 10-14 mm based on patient factors or evidence of growth at follow-up imaging 1.
Management and Treatment
- If you're experiencing pain and have been diagnosed with gallbladder polyps larger than 10 mm, medical intervention is often recommended, typically involving surgical removal of the gallbladder (cholecystectomy) 1.
- Smaller polyps under 10 mm are less likely to cause symptoms and may simply require monitoring with regular ultrasounds to check for growth.
- It is essential to consult with your healthcare provider promptly for proper evaluation and management if you have gallbladder polyps and are experiencing pain.
From the Research
Gallbladder Polyps and Pain
- Large gallbladder polyps can cause pain, although the evidence is not entirely clear on this topic 2, 3.
- A study from 2005 suggests that patients with biliary pain and small gallbladder polyps without gallstones present a difficult management decision for the clinician, and that cholecystectomy may be considered if the physician is confident that the polyps are the source of the pain 3.
- Another study from 2022 recommends cholecystectomy for patients with polypoid lesions of the gallbladder measuring 10 mm or more, or for patients with a polypoid lesion and symptoms potentially attributable to the gallbladder if no alternative cause for the patient's symptoms is demonstrated 4.
- The size of the polyp and the patient's age are important risk factors for malignant potential, and patients with symptoms and large polyps should be considered for cholecystectomy 2, 5.
Diagnosis and Management
- Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling gallbladder polyps 2, 4.
- Endoscopic ultrasound may be useful in assessing the malignant potential of large gallbladder polyps, but its use is not routinely recommended 4, 6.
- 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, 4.
- Follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year, and 2 years for patients with gallbladder polypoid lesions of 6-9 mm, or for patients with risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less 4.