From the Guidelines
Management of gallbladder polyps depends primarily on their size and risk factors for malignancy, with polyps smaller than 10mm generally requiring surveillance with ultrasound every 6-12 months, while polyps 10mm or larger typically warrant surgical removal via cholecystectomy due to increased cancer risk. The most recent and highest quality study, 1, recommends the following management approach for gallbladder polyps:
- No follow-up is recommended for polyps of 6 mm or smaller
- Follow-up US at 12 months is recommended for polyps measuring 7–9 mm
- Follow-up US at 6,12,24, and 36 months is recommended for polyps measuring 10–14 mm
- Surgical consultation is recommended for polyps of 15 mm or larger
- If, at follow-up, a polyp has increased in size by 4 mm or more within a 12-month period or reaches 15 mm, surgical consultation is recommended Risk factors that may lower the threshold for surgical intervention include age over 50, concurrent gallstones, rapid polyp growth (more than 2mm in 6 months), sessile polyps, and solitary polyps, as noted in 1 and 1. Laparoscopic cholecystectomy is the standard surgical approach, with conversion to open surgery if needed, as stated in 1. There are no effective medical therapies to shrink or eliminate gallbladder polyps, as mentioned in 1 and 1. The rationale for this management approach is that while most gallbladder polyps are benign cholesterol polyps, approximately 3-5% are adenomas with malignant potential or early carcinomas, and size is the most reliable predictor of malignancy risk, as discussed in 1 and 1. Patients should be counseled that most small polyps remain stable or may even regress, but regular follow-up is essential to monitor for concerning changes, as emphasized in 1 and 1.
From the Research
Diagnosis and Management of Gallbladder Polyps
- The primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound 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, 3, 4, 5.
- 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.
Risk Factors for Malignancy
- 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, 3, 5.
- Cholecystectomy is recommended if the patient has a 6-9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, and the patient is fit for, and accepts, surgery 2.
Follow-up and Surveillance
- Follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year, and 2 years for patients with a gallbladder polypoid lesion of 6-9 mm and no risk factors for malignancy, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less 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, 6, 5.