From the Guidelines
The treatment for gallbladder polyps should be based on a multifactorial approach, considering the size and characteristics of the polyp, as well as the patient's overall health status and risk profile, with surgical removal of the gallbladder (cholecystectomy) recommended for polyps larger than 10mm due to the increased risk of malignancy, as suggested by the Society of Radiologists in Ultrasound consensus conference recommendations 1.
Key Considerations
- The size of the polyp is a crucial factor in determining the treatment approach, with polyps larger than 10mm having a higher likelihood of harboring cancer cells 1.
- Patient selection for surgery should be based on shared decision-making, taking into account the patient's health status, risk profiles of imaging findings, and the potential risks and benefits of surgery 1.
- Laparoscopic cholecystectomy is the preferred surgical approach, involving 3-4 small incisions and typically requiring 1-2 days of hospitalization with a recovery period of 1-2 weeks.
- Patients with symptoms such as pain or inflammation may need surgery regardless of polyp size.
- There are no effective medications to shrink or eliminate gallbladder polyps.
Special Considerations
- For patients with primary sclerosing cholangitis (PSC), cholecystectomy is recommended for polyps greater than or equal to 8mm in size, or smaller polyps that are growing in size, due to the high risk of malignancy or dysplasia 1.
- Small non-contrast-enhancing polyps should be followed-up for growth with a repeat ultrasound after 3-6 months, while contrast-enhancing polyps should be considered for cholecystectomy regardless of size 1.
Risks and Benefits
- The risk of morbidity associated with cholecystectomy is minimal, but can be increased in patients with underlying comorbidities or those undergoing surgery in the setting of acute illness 1.
- The risk of mortality associated with cholecystectomy is also minimal, but can be increased in patients with severe disease stages or liver decompensation 1.
- The benefits of surgery, including the elimination of the risk of malignancy, must be carefully weighed against the potential risks and benefits of surgery on a case-by-case basis.
From the Research
Treatment of Gallbladder Polyps
The treatment for gallbladder (cholecystic) polyps depends on various factors, including the size of the polyp, symptoms, and risk factors for malignancy.
- Cholecystectomy is recommended for patients with polyps measuring 10 mm or larger, as well as for symptomatic patients with polyps measuring less than 10 mm 2, 3, 4, 5.
- For polyps measuring 6-9 mm, a cholecystectomy is recommended if one or more risk factors for malignancy are present, such as age older than 60 years, primary sclerosing cholangitis, Asian ethnicity, and sessile polyps, including focal gallbladder wall thickening >4 mm 2.
- Follow-up ultrasound is recommended at six months, one year, and two years for polyps measuring 6-9 mm in patients without risk factors for malignancy, and for polyps less than 5 mm in patients with one or more risk factors for malignancy 2.
- Discontinuing the surveillance could be considered in the absence of growth 2.
- No treatment is required in young patients with very small gallbladder polyps who are completely free from any symptoms, and a "watch-and-wait" strategy seems to be recommendable for polyps less than 10 mm that are incidentally identified and not removed 5.
Surgical Treatment
Surgical treatment, such as laparoscopic cholecystectomy, is often performed for gallbladder polyps, especially for those that are large or symptomatic.
- Laparoscopic cholecystectomy is a common treatment approach for patients with polyps larger than 10 mm in diameter 3, 4.
- Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy 3.
- Indications for surgical treatment also seem reasonable in case of patients with present polyps and coexisting right upper quadrant pain 4.