Korean J Gastroenterol.  2020 Sep;76(3):102-107. 10.4166/kjg.2020.76.3.102.

Recent Updates on Diagnosis, Treatment, and Follow-up of Gallbladder Polyps

• Jang SI
• Cho JH
• Lee DK

• KMID: 2506667
• DOI: http://doi.org/10.4166/kjg.2020.76.3.102

Abstract

A gallbladder (GB) polyp is an elevation of the GB mucosa that protrudes into the GB lumen. GB polyps have an estimated prevalence of 0.3-9.5% and can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps). Pseudopolyps are most commonly cholesterol polyps but also include focal adenomyomatosis and inflammatory polyps with no malignant potential. Neoplastic polyps, however, can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are usually adenocarcinoma. Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling GB polyps. On the other hand, because it is difficult to diagnose GB polyps before surgery, alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated. The current guidelines recommend cholecystectomy for GB polyps ≥ 10 mm in size as well as suboptimal sized GB polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms. The quality of the evidence behind this practice is relatively low. Therefore, this review identifies the current gaps in the available evidence and guidelines and introduces methods that can help make decisions regarding patients who require a cholecystectomy or follow-up.

Keyword

Gallbladder polyp; Gallbladder diseases; Gallbladder neoplasms; Diagnosis; Therapy

Figure

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  Fig. 1 (A) microscopic feature of an adenomatous polyp. The polyp was composed of a glandular structure with a tall columnar epithelium and stroma. In the center, a dilated gland and vessels surrounded by loose connective tissue were noted (H&E staining, ×40), (B) microscopic features of a cholesterol polyp. Lipid laden macrophage containing a polyp was observed (H&E staining, ×40).

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  Fig. 2 Management and follow-up of gallbladder polyps according to 2017 European joint guidelines.

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  Fig. 3 (A) Color Doppler flow endoscopic ultrasonography image shows a strong continuous flow in an adenomatous polyp, which is compatible with prominent small feeding arterioles in gallbladder polyps. (B) Class activation map of a gallbladder polyp in the image classification through deep learning of the endoscopic ultrasonography-artificial intelligence system.

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