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. 2025 Jul 23.
doi: 10.1002/ueg2.70057. Online ahead of print.

Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Mike van Dooren  1 , Elise A J de Savornin Lohman  1 , Jarmila van der Bilt  2 , Marieke T de Boer  3 , Djamila Boerma  4 , Philip Bos  5 , Andries E Braat  6 , Steve M M de Castro  7 , Bartholomeus J G A Corten  8 , Freek Daams  9 , Joris I Erdmann  10 , Floris Ferenschild  11 , Ansje S Fortuin  12 , Nanette van Geloven  13 , Erik van der Hoeven  14 , Rutger Klicks  15 , Flip M Kruyt  16 , Barbara S Langenhoff  17 , Mike S L Liem  18 , Philip V M Linsen  19   20 , Misha Luyer  21 , Vincent B Nieuwenhuijs  22 , Pim Olthof  23 , Peter W Plaisier  24 , Charles van Rossem  25 , Ruud Schrauwen  26 , Jennifer Schreinemakers  27 , Gian Piero Serafino  20 , Ernst Jan Spillenaar Bilgen  28 , Koen Talsma  29 , Merel M Tielemans  30 , Charlotte J Tutein Nolthenius  14 , Philip de Reuver  1
Affiliations
Free article

Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Mike van Dooren et al. United European Gastroenterol J. .
Free article

Abstract

Background: Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.

Methods: Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.

Results: A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9-47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

Discussion: Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.

Keywords: adenoma; cholecystectomy; dysplasia; follow‐up; gallbladder polyps; gallbladder wall; guidelines; malignancy; non‐neoplastic polyps.

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