Gallbladder polypoid lesions: Current practices and future prospects

Abstract

Gallbladder polypoid lesions (GPLs) refer to any elevated lesion of the mucosal surface of the gallbladder wall, and the prevalence is estimated to be between 0.9% and 12.1%. GPLs include benign polyps and malignant polyps. Benign polyps are further classified as non-neoplastic polyps and neoplastic polyps. Cholesterol polyps are the most common benign polyps and adenocarcinoma is the main type of malignant polyp. Hepatitis B virus infection, liver function abnormalities, dyslipidemia, and obesity are the main risk factors for GPLs. Studies of biological mechanisms have focused on malignant gallbladder polyps, the development of which is regulated by hormone levels in vivo , gut microbiota, inflammation, oxidative stress, Salmonella typhimurium , and related molecules. Diagnostic modalities include chemical examination and imaging examination, with imaging examination currently being the mainstay. Treatment of patients with GPLs is based on the presence or absence of symptoms, age, size of the polyps, tendency of the polyp to increase, and risk factors for symptomatic malignancy to determine whether surgery should be performed.

Figure 1

Recommended treatment strategies for GPLs. GPLs: Gallbladder polypoid lesions.

Figure 2

Transgastric gallbladder-preserving polyp resection. (A) A hybrid knife or an insulated tip knife was used to make a full-thickness incision on the anterior wall and greater curvature of the gastric antrum. (B) An endoscope was inserted through the incision and the gallbladder was found. (C) A small incision was made at the bottom of the gallbladder, and the endoscope was used to probe the gallbladder lumen after the bile was completely suctioned. (D) Endoscopy access to the gallbladder reveals polyp. (E) The gallbladder polyp was resected using a looper. (F) Image of location where a polyp was removed. (G) Several clips were used to close the gallbladder incision. (H) Closure of the gastric incision site was achieved with clips.