Management

Treatment

• symptomatic patients (1)
  • cholecystectomy is recommended for patients who have biliary colic or pancreatitis, since an appreciable proportion of such patients with cholesterolosis or adenomyomatosis improve after cholecystectomy
  • patients with non-specific dyspeptic symptoms but without symptoms consistent with biliary colic should be managed conservatively (unless other indications for polyp removal are present) since the pathogenesis of these symptoms is unclear and cholecystectomy may not relieve the symptoms (2)
    
    
• asymptomatic patients — management depends upon the size of the polyps
  • lesions larger than 20 mm — Lesions larger than 20 mm in diameter are usually malignant and should be resected
    • because these lesions may represent advanced cancer, patients should undergo preoperative staging with a computed tomographic (CT) scan and endoscopic ultrasound. An extended cholecystectomy with lymph node dissection and partial hepatic resection in the gallbladder bed is required when performing cholecystectomy for malignancy (2)
      
      
  • lesions from 10 to 20 mm — should be regarded as possibly malignant
    
    
  • lesions from 6 to 9 mm — Lesions 6 to 9 mm in diameter may represent cholesterol polyps, adenomas, or carcinomas
    • multiple polyps, pedunculated polyps, and those that are hyperechoic compared with the liver are usually cholesterol polyps, while solitary and sessile polyps that are isoechoic with the liver are more likely to be neoplastic
      
      
  • lesions 5 mm or smaller — Polyps ≤5 mm are usually benign and most frequently represent cholesterolosis
    
    
  • patients with known PSC are at higher risk to develop gallbladder cancer and hence a cholecystectomy is recommended for polyps smaller than 10 mm. In addition, patients with gall stones and polyps ought to undergo a cholecystectomy because of the risk of cancer from gall stones (2)

Reference:

1. Boulton RA, Adams DH. Gallbladder polyps: when to wait and when to act., Lancet 1997;349: 817.
2. NHS West Mids (April 2020). West Midlands Cancer Alliance Hepatobiliary Gallbladder Polyps Management Guidelines
3. Koga A et al. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 1992; 79: 227-29.