From the Research
In the UK, the most recent guidelines for gallbladder polyp surveillance recommend that polyps smaller than 5mm require no follow-up, unless the patient has risk factors for malignancy, as stated in the 2022 joint guidelines between the ESGAR, EAES, EFISDS, and ESGE 1. The guidelines suggest that polyps between 6-9mm should be monitored with ultrasound at 6 months, 1 year, and 2 years, and follow-up should be discontinued after 2 years in the absence of growth 1. Key points to consider in the management of gallbladder polyps include:
- Polyp size: polyps 10mm or larger warrant consideration for cholecystectomy due to increased malignancy risk 1
- Risk factors for malignancy: age over 60, history of primary sclerosing cholangitis, Asian ethnicity, and sessile polypoid lesions 1
- Surveillance schedule: can be reduced after 2 years of stability, but patients should be advised to report new or worsening symptoms such as right upper quadrant pain 1
- Ultrasound: is the primary investigation of choice for gallbladder polyps, with other imaging modalities reserved for difficult cases or when ultrasound is inconclusive 1 The 2022 guidelines provide a framework for the management of gallbladder polyps, balancing the need for early detection of potentially malignant lesions against the risk of unnecessary interventions 1. It is essential to note that the guidelines are based on the latest evidence and expert consensus, and clinicians should consider individual patient factors and risk profiles when making decisions about surveillance and management 1.