From the Guidelines
The recommended treatment for gallbladder polyps depends primarily on their size and characteristics, with watchful waiting for polyps smaller than 10mm and cholecystectomy for polyps larger than 10mm or those with rapid growth, symptoms, or risk factors for gallbladder cancer, as supported by the Society of Radiologists in Ultrasound consensus conference recommendations 1. For polyps smaller than 10mm, watchful waiting with regular ultrasound monitoring every 6-12 months is typically recommended, as these are often benign and may not require intervention. However, for polyps larger than 10mm, cholecystectomy (surgical removal of the gallbladder) is generally advised due to the increased risk of malignancy. Some key points to consider in the management of gallbladder polyps include:
- Polyp size: Polyps larger than 10mm are associated with a higher risk of malignancy, and cholecystectomy is recommended for these patients, as stated in the study by Liu et al 1.
- Growth rate: Rapid growth of a polyp, defined as an increase in size of 4mm or more within a 12-month period, is a concern for malignancy and warrants surgical consultation, as noted in the study by Patel et al 1.
- Symptoms: Patients with symptoms such as pain or inflammation should undergo surgical consultation, regardless of polyp size, as recommended by the Society of Radiologists in Ultrasound consensus conference guidelines 1.
- Risk factors: Patients with risk factors for gallbladder cancer, such as being over 50 years old or having a history of primary sclerosing cholangitis, should undergo surgical consultation, as advised by the European Association for the Study of the Liver and American Association for the Study of Liver Diseases guidelines 1. Laparoscopic cholecystectomy is the preferred surgical approach, involving 3-4 small incisions rather than a large open procedure, which allows for faster recovery and less post-operative pain, as stated in the study by Wennmacker et al 1. There are no effective medications to treat or shrink gallbladder polyps. After cholecystectomy, patients typically recover within 1-2 weeks and can return to normal activities, though they may need to temporarily avoid fatty foods to prevent digestive discomfort as their body adjusts to functioning without a gallbladder, as noted in the study by Kim et al 1. It is essential to weigh the risks and benefits of surgery, considering the patient's overall health status and risk profile, as recommended by the Society of Radiologists in Ultrasound consensus conference guidelines 1.
From the Research
Treatment Options for Gallbladder Polyps
The treatment for gallbladder polyps depends on various factors, including the size of the polyp, symptoms, and risk factors for malignancy.
- Cholecystectomy is recommended for patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery 2.
- For patients with a polypoid lesion and symptoms potentially attributable to the gallbladder, cholecystectomy is suggested 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.
- Risk factors for malignancy include age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, and sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm) 2.
Follow-Up and Surveillance
For patients with gallbladder polyps, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year, and 2 years if the patient has a 6-9 mm polypoid lesion and no risk factors for malignancy, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less 2.
- Follow-up should be discontinued after 2 years in the absence of growth 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 the polypoid lesion grows by 2 mm or more within the 2-year follow-up period, then the current size of the polypoid lesion should be considered along with patient risk factors 2.
Alternative Treatment Options
Endoscopic ultrasound-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) is a novel approach for the treatment of patients with gallbladder polyps and symptomatic gallstones 3.
- This approach allows for per-oral transmural endoscopic resection of gallbladder polyps, avoiding the need for cholecystectomy 3.
- However, further studies are needed to determine the safety and efficacy of this approach 3.
Diagnosis and Imaging
Abdominal sonography is the first-line study for diagnosis and follow-up of gallbladder polyps 2, 4.