From the Guidelines
Sessile polyps of the gallbladder that are 15 mm or larger should be referred for surgical consultation due to their increased risk of malignancy. Sessile polyps are defined as flat or dome-shaped masses that extend from the mucosal layer and do not have a stalk, with a broad-based point of attachment to the wall 1. According to the Society of Radiologists in Ultrasound consensus conference recommendations, sessile polyps are categorized as low-risk polyps, and the management strategy is based on their size 1. For polyps of 6 mm or smaller, no follow-up is recommended, while follow-up US at 12 months is recommended for polyps measuring 7–9 mm, and follow-up US at 6,12,24, and 36 months is recommended for polyps measuring 10–14 mm 1.
Key considerations in the management of sessile gallbladder polyps include:
- Size of the polyp: polyps 15 mm or larger should be referred for surgical consultation 1
- Growth of the polyp: if a polyp increases in size by 4 mm or more within a 12-month period, surgical consultation is recommended 1
- Clinical status of the patient: patients with risk factors for gallbladder cancer, such as primary sclerosing cholangitis, may require more aggressive management 1
- Symptoms: patients experiencing symptoms like pain or inflammation may require surgical removal of the gallbladder 1
Regular follow-up imaging every 6-12 months is essential for smaller polyps to monitor for any changes in size or characteristics 1. Patients should be informed about potential symptoms that warrant immediate medical attention, including right upper quadrant pain, jaundice, or unexplained weight loss. The concern with sessile polyps is their higher malignant potential compared to pedunculated (stalked) polyps, particularly if they are larger 1.
From the Research
Sessile Polyps of Gallbladder
- Sessile polyps are a type of gallbladder polyp that are attached to the gallbladder wall by a broad base, rather than a pedicle 2.
- The risk of malignancy is higher in sessile polyps compared to pedunculated polyps 2.
- According to the updated joint guidelines between the ESGAR, EAES, EFISDS, and ESGE, cholecystectomy is recommended for patients with a polypoid lesion of the gallbladder measuring 10 mm or more, including sessile polyps 3.
- For patients with a 6-9 mm polypoid lesion of the gallbladder, including sessile polyps, and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery 3.
- 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) 3.
Diagnosis and Management
- Primary investigation of polypoid lesions of the gallbladder, including sessile polyps, should be with abdominal ultrasound 3.
- If the patient has a sessile polypoid lesion of the gallbladder 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 3.
- For patients with a sessile polypoid lesion of the gallbladder smaller than 10 mm, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year, and 2 years, and follow-up should be discontinued after 2 years in the absence of growth 3.
Prognosis and Treatment
- The prognosis for patients with sessile polyps of the gallbladder is generally good if the polyp is removed surgically before it becomes malignant 2.
- Laparoscopic cholecystectomy is a safe and feasible method for treating gallbladder polypoid lesions, including sessile polyps 4.
- According to a clinicopathologic study, neoplastic change in polypoid lesions of the gallbladder should be considered when a patient older than 50 years of age has a polypoid lesion larger than 1.0 cm, and cancer should be suspected when a polypoid lesion of the gallbladder is larger than 1.5 cm 4.