Management and follow-up of gallbladder polyps

Rebecca Wiles,Yogesh K Vashist,Julie Perinel,Max Lahaye,Søren Rafael Rafaelsen,Ruedi F Thoeni,Stuart Ashley Roberts,Marianna Arvanitakis,Marek Soltes,Catherine Dewhurst,Sorin Traian Barbu

doi:10.1007/s00330-017-4742-y

Abstract

ObjectivesThe management of incidentally detected gallbladder polyps on radiological examinations is contentious. The incidental radiological finding of a gallbladder polyp can therefore be problematic for the radiologist and the clinician who referred the patient for the radiological examination. To address this a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE).MethodsA targeted literature search was performed and consensus guidelines were created using a series of Delphi questionnaires and a seven-point Likert scale.ResultsA total of three Delphi rounds were performed. Consensus regarding which patients should have cholecystectomy, which patients should have ultrasound follow-up and the nature and duration of that follow-up was established. The full recommendations as well as a summary algorithm are provided.ConclusionsThese expert consensus recommendations can be used as guidance when a gallbladder polyp is encountered in clinical practice.Key Points• Management of gallbladder polyps is contentious• Cholecystectomy is recommended for gallbladder polyps >10 mm• Management of polyps <10 mm depends on patient and polyp characteristics• Further research is required to determine optimal management of gallbladder polyps

Highlights

Gallbladder polyps are elevations of the gallbladder wall that project into the lumen
The full recommendations as well as a summary algorithm are provided. These expert consensus recommendations can be used as guidance when a gallbladder polyp is encountered in clinical practice
Cholecystectomy is recommended for gallbladder polyps

Summary

Introduction

Gallbladder polyps are elevations of the gallbladder wall that project into the lumen. They are commonly detected on ultrasound scans of the abdomen, with a prevalence estimated between 0.3 and 9.5%. They may be found following analysis of the gallbladder specimen following cholecystectomy [1,2,3,4,5]. Gallbladder polyps can be divided into pseudopolyps and true gallbladder polyps. Pseudopolyps are more common than true polyps. True gallbladder polyps can be benign or malignant. Benign polyps are most commonly adenomas while malignant polyps are usually adenocarcinomas. There are rare types of benign and malignant true gallbladder polyps, including mesenchymal tumours, lymphoma and metastases [7]. The evidence that exists, suggests that at least some gallbladder adenocarcinomas have arisen in pre-existing adenomas [8,9,10] and as such the adenoma–carcinoma sequence is likely, at least for some cases

Objectives

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Conclusion