Is there A Standard Strategy for Managing Gall Bladder Polyps?
AE Elkak Department Of Oncology, The Royal Hospital, Muscat, Oman
Published on: 2018-09-08
Gall bladder polyps (GBPs) are a common problem. Pathology: 70% of GBPs are cholesterol polyps. Adenomas are the next common category. Adenomas can turn into adenocarcinomas. The risk of maliganancy is small but real. Polyps larger than 10 mm and patients older than 50 years are the two main risks for malignancy. Diagnosis: Most polyps are asymptomatic diagnosed incidentally in the course of investigations for other abdominal conditions. Less than 10% of polyps present symptomatically with indigestion, flatulence, nausea, right upper quadrant pain and discomfort or symptoms of cholecystitis. It is not clear how much of these symptoms can be caused by the actual polyps. Investigations: Ultrasound is usually the first investigation performed. CT is performed either to investigate other abdominal conditions or to further investigate equivocal ultrasound findings. EUS is a better modality than transabdominal ultrasound but it is not normally used as the first line of imaging. Management: There is no unified policy to manage GBPs. Laparoscopic cholecystectomy should be offered to patients over 50 years, if polyps are larger than 10 mm, if polyps increase in size during follow up or if the polyps are symptomatic. Management of polyps which fall outside these criteria is debatable. There should be a clear and open discussion between the surgeon and the patient especially if the patients do not quite fulfil the criteria for cholecystectomy.
Gall Bladder Polyps; Cholesterol Polyps; Gall Bladder Adenoma
Polypoid lesions of the gall bladder may be defined as elevations of the gall bladder mucosa. They are a common problem in clinical practice. More polypoid lesions of the gall bladder are detected with the increasing use of ultrasound and CT in clinical practice. Because of the risk of malignant transformation and the well known dismal prognosis of gall bladder cancer, it is important to establish a management strategy for gall bladder polyps. There is no strong agreement in the literature as to what the natural course and optimal management of the polyps are. Management is rather arbitrary and inconsistent in many hospitals. Not infrequently, decisions are based on individual expert opinion (level IV evidence). This review aims to provide some understanding of the pathology, behaviour and diagnosis of gall bladder polyps (GBP) and discuss the different management options.