Gallbladder polyps: how should they be treated and when?

Abstract

Objective: The objective of this study was to determine the correct therapeutic management for patients with gallbladder polyps (GPs), what type of surveillance should be employed and how to differentiate between benign and malignant polyps in addition to also to providing reassurance in cases of "cancerophobia".

Study design: This was a 5-years retrospective study.

Location: The study was conducted at a Surgery Department at the Hospitais da Universidade de Coimbra.

Population: We analyzed all patients operated on at the Surgery Service II from January 2003 to December 2007 who had had a preoperative diagnosis of GP.

Methods: Clinicopathological correlations were traced for all patients. The following were analyzed: demographic data, clinical presentation, principal symptoms, associated pathologies, supplementary tests and diagnoses.

Results: We studied 93 patients, 91 of whom had benign polyps and two of whom had malignant polyps. Of the 91 benign polyps, 73 (78.5%) were cholesterol polyps, 14 (15%) were hyperplastic and two (2.2%) were adenomas. Two (2.2%) patients had malignant polyps, both adenogallbladder carcinomas. The mean diameter of benign polyps was 6 mm and 40 (43%) patients had multiple lesions. The mean diameter of malignant and premalignant polyps taken together was 18.8 mm, all were single polyps and the mean age of this patient subset was 57.7 years.

Conclusion: It was concluded that the surgical option for GPs is cholecystectomy and that this should only be undertaken in cases where there are clinical signs of GP; polyps with diameters greater than 10 mm; fast-growing polyps; sessile polyps or wide-based polyps; polyps with long pedicles; patient aged over 50; concurrent gallstones; polyps of the gallbladder infundibulum or abnormal gallbladder wall ultrasound.