What is the treatment for a 2 millimeter gallbladder (biliary) polyp?

From the Guidelines

For a 2 mm gallbladder polyp, no specific treatment is typically needed as these are considered too small to warrant intervention. The standard approach is watchful waiting with no follow-up ultrasound imaging recommended for polyps of 9 mm or smaller, as stated by the Society of Radiologists in Ultrasound consensus conference recommendations 1. These tiny polyps are almost always benign and have an extremely low risk of malignancy, with studies showing 0% malignancy in polyps smaller than 5 mm 1. If you have symptoms like abdominal pain, these are likely unrelated to such a small polyp and should be evaluated separately. No medications are required specifically for the polyp itself.

Key Considerations

• The risk of malignancy increases with polyp size, but polyps smaller than 10 mm have a very low risk of cancer 1
• The SRU consensus conference committee recommends no follow-up for polyps of 9 mm or smaller 1
• Surgical consultation is recommended for polyps of 15 mm or larger, or if a polyp grows by 4 mm or more within a 12-month period 1

Management Approach

• Watchful waiting with no follow-up ultrasound imaging for polyps of 9 mm or smaller
• Follow-up ultrasound imaging at 6,12, and 24 months for polyps measuring 10-14 mm, with surgical consultation considered based on patient factors or evidence of growth 1
• Surgical removal of the gallbladder (cholecystectomy) may be considered if the polyp grows to exceed 10 mm, develops concerning features on imaging, or if symptoms specifically related to the gallbladder develop.

From the Research

Gallbladder Polyp Treatment

• A 2 mm gallbladder polyp is considered small and may not require immediate treatment 2, 3.
• According to the 2022 guidelines, 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.
• However, some studies suggest that surveillance may not be needed for gallbladder polyps <5 mm, but for polyps between 5 and 10 mm, two scans at six monthly intervals may be suggested 3.
• The primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound, and routine use of other imaging modalities is not recommended presently 2.
• 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.

Diagnostic Approaches

• Ultrasound is the first-choice imaging method for the diagnosis of gallbladder polyps, representing an indispensable tool for ensuring appropriate management 4.
• Transabdominal ultrasound (TAUS) and endoscopic ultrasound (EUS) can be used for the diagnosis of gallbladder polyps, but TAUS seems quite good at discriminating between gallbladder polyps and no polyps, while EUS may be useful in differentiating between true and pseudo polyps 5.
• The diagnostic accuracy of TAUS and EUS for the detection of gallbladder polyps, differentiation between true and pseudo polyps, and differentiation between dysplastic polyps/carcinomas and adenomas/pseudo polyps has been evaluated in several studies 5.

Risk Factors and Management

• Risk factors for malignancy, such as age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, and sessile polypoid lesion, should be considered when managing gallbladder polyps 2, 6.
• The Society of Radiologists in Ultrasound (SRU) consensus committee guidelines provide recommendations for the management of incidentally detected gallbladder polyps, including follow-up and treatment strategies based on polyp size, morphology, and patient risk factors 6.