Gallbladder polyps versus cancer: is there a role for prevention? Single centre six-year experience in management of gallbladder polyps

Abstract

Background: Gallbladder polyps (GBPs) are common, while GB cancer is rare & often presents at late stages (5-year survival 3%). GBPs 1-2cm are associated with 43-77% cancer incidence, while polyps >2cm are almost always 100% malignant. Our aim is to assess management of GBPs in the absence of UK guidelines. Methods: 1743 ultrasound scans (USS) & clinic letters reviewed from Hospital database. Results: 115 patients were diagnosed with GBPs over 6-year period, Jan 2011 - Dec 2016. Male to Female ratio was 48:67 with median age of 55 (24-83). 18 patients had other imaging to confirm diagnosis, where 15 patients had MRI & three had CT. USS showed increased size of GBPs in 52 patients over median period of 12 months (8-60). 7 patients had laparoscopic cholecystectomy and all had evidence of chronic cholecystitis with Rokitansky Aschoff sinuses. 35 patients were discharged from clinic back to their general practitioner(GP). 30 patients are followed up in the Upper GI clinic, 29 with Gastroenterology & 17 had unclear follow-up. Conclusion: USS is the imaging of choice for follow-up. GBPs increasing in size or in cases with discrepancies, we advise follow-up USS to be done by the same sonographer or consultant Radiologist. Annual follow-up USS is advised as no remarkable increase in size occurred in less than 1 year. Patients with GBPs≥8mm should be offered laparoscopic cholecystectomy in the surgical clinic. Elective surgery for GBPs is safe as all patients only had chronic cholecystitis with Rokitansky Aschoff sinuses & no cancer.