Citation Information :
Dilek ON, Karasu S, Dilek FH. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019; 9 (1):40-48.
Introduction: Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development.
Materials and methods: GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0–27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps.
Results: Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas.
Conclusion: Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3–12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy.
Lee KF, Wong J, et al. Polypoid lesions of the gallbladder. Am J Surg 2004;188:186-190.
Terzi C, Sökmen S, et al. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 2000;127:622-627.
Csendes A, Burgos AM, et al. Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Am Surg 2001;234: 657-660.
Sun XJ, Shi JS, et al. Diagnosis and treatment of polipoid lesions of the gallbladder: report of 194 cases. Hepatobiliary Pancreat Dis Int 2004;3:591-594.
Moriguchi H, Tazawa J, et al. Natural history of polypoid lesions in the gallbladder. Gut 1996;39:860-862.
Bilhartz LE. Polyps of the gallbladder. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 7th ed. W.B. Saunders Co., Philadelphia, 2002, p. 1125-1130.
Jorgensen T, Jensen KH. Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol 1990;25:281-286.
Jensen KH, Jorgensen T. Incidence of gallstones in a Danish population. Gastroenterology 1991;100:790-794.
Lee YJ, Park KS, et al. Shifting prevalence of gallbladder polyps in Korea. J Korean Med Sci 2014;29:1247-1252.
Segawa K, Arisawa T, et al. Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am J Gastroenterol 1992;87:630-633.
Ozmen MM, Patankar RV, et al. Correspondence. Epidemiology of gallbladder polyps. Scand J Gastroenterol 1994;29:480.
Stringer MD, Ceylan H, et al. Gallbladder polyps in children classification and management. J Pediatr Surg 2003;38:1680-1684.
Albores-Saavedra J, Klöppel G, et al. Carcinoma of the gallbladder and extrahepatic bile ducts. In: Bosman FT, Carneiro F, Hruban RH, et al. (Eds), World Health Organization Classification of Tumours of the Digestive System. 4th ed. WHO Press, Geneva, 2010, pp. 263-278.
Mizobuchi N, Munechika J, et al. Three cases of intracystic papillary neoplasm of gallbladder. Abdom Radiol (NY) 2018;43:1535-1539.
Jütte H, Tannapfel A. Tumor grading of the hepatobiliary system [In German with English abstract]. Pathologe 2016;37:299-303.
Ljubicic N, Zovak M, et al. Management of gallbladder polyps: An optimal strategy proposed. Acta Clin Croat 2001;40:57-60.
Li XY, Zheng CJ, et al. Diagnosis and treatment of polypoid lesion of the gallbladder. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003;25:689- 693.
Smok G, Bentjerodt R, et al. Benign polypoid lesions of the gallbladder. Their relation to gallbladder adenocarcinoma. Rev Med Chil 1992;120:31-35.
Elmasry M, Lindop D, et al. The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review. Int J Surg 2016;33:28-35.
Liu YL, Wang JT. Hypeplastic cholecystoses: effort should be made to recognize and treat them. HB Panc Dis Int 2006;5:334-336.
Kozuka S, Tsubone M, et al. Relation of adenoma to carcinoma in the gallbladder. Cancer 1982;50:2226-2234.
Gouma DJ. When are gallbladder polyps malignant? HPB Surg. 2000;11:428-430.
Vijayakumar A, Vijayakumar A, et al. Early diagnosis of gallbladder carcinoma: An algorithm approach. ISNR Radiology, 2013.
Roa I, de Aretxabala X, et al. Clinicopathological features of gallbladder polyps and adenomas. Rev Med Chil 2004;132: 673-679.
Chattopadhyay D, Lochan R, et al. Outcome of gallbladder polypoidal lesions detected by transabdominal ultrasound scanning: A nine year experience. World J Gastroenterol 2005;11:2171-2173.
Persley KM. Gallbladder polyps. Curr Treat Options Gastroenterol 2005;8:105-108.
De Matos ASB, Baptista HN, et al. Gallbladder polps; How should they be treated and when? Res Assoc Med Bras 2010;56:318-321.
Ootani T, Shirai Y, et al. Relationship between gallbladder carcinoma and the segmental type of adenomyomatosis of the gallbladder. Cancer 1992;69:2647-2652.
Bonatti M, Vezzali N, et al. Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. Insights Imaging 2017;8:243-253.
Raghavendra BN, Subramanyam BR, et al. Sonography of denomyomatosis of the gallbladder: radiologic-pathologic correlation. Radiology 1983;146:747-752.
Espinoza JA, Bizama C, et al. The inflammatory inception of gallbladder cancer. Biochim Biophys Acta 2016;1865:245-254.
Kumar S, Kumar S, et al. Infection as a risk factor for gallbladder cancer. J Surgical Oncol 2006;93:633-639.
Erden A, Songür Y, et al. The role of color Doppler ultrasonography in the differentiation of gallbladder lesions. Turkish J Gastroenterol 1999;10:132-137.
Sun LP, Guo LH, et al. Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration. Int J Clin Exp Med 2015;8:1115-1121.
Collett JA, Allan RB, et al. Gallbladder polyps: prospective study. Journal of Ultrasound in Medicine 1998;4:207-211.
Martin E, Gill R, et al. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg 2018;61:200-207.
Kubota K, Bandai Y, et al. How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 1995;117:481-487.
Choi WB, Lee SK, et al. A new strategy to predict the neoplastic polyps of the gallbladder based on a scoring system using EUS. Gastrointestinal Endoscopy 2000;52:372-379.
Azuma T, Yoshikawa T, et al. Differential diagnosis of polypoid lesions of gallbladder by endoscopic ultrasonography. Am J Surg 2001;181:65- 70.
Sadamoto Y, Oda S, et al. A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder, utilizing an endoscopic ultrasound scoring system. Endoscopy 2002;34:959-965.
Kimura K, Fujita N, et al. Differential diagnosis of large-sized pedunculated polypoid lesions of the gallbladder by endoscopic ultrasonography: a prospective study. J Gastroenterol 2001;36:619- 622.
Sugahara E, Nakajima M, et al. Management of polypoid lesions of the gallbladder by endoscopic ultrasonography (EUS)--a retrospective study to establish the diagnostic criteria and a prospective study to evaluate its reliability. Nihon Shokakibyo Gakkai Zasshi 1995;92:1846-1857.
Sugiyama M, Atomi Y, et al. Endoscopic ultrasonography for differential diagnosis of polypoid gallbladder lesions: analysis in surgical and follow up series. Gut 2000;46:250-254.
Wu SS, Lin KC, et al. Ultrasound-guided percutaneous transhepatic fine needle aspiration cytology study of gallbladder polypoid lesions. Am J Gastroenterol 1996;91:1591-1594.
Rana C, Krishnani N, et al. Ultrasound-guided fine needle aspiration cytology of gallbladder lesions: a study of 596 cases. Cytopathology 2016;27:398-406.
Heimbach JK, Sanchez W, et al. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford) 2011;13:356-360.
Ogura T, Kurisu Y, et al. Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for thick-walled gallbladders? Dig Dis Sci 2014;59:1917-1924.
Kapoor A, Kapoor A, et al. Differentiating malignant from benign thickening of the gallbladder wall by the use of acoustic radiation force impulse elastography. J Ultrasound Med 2011;30:1499-1507.
Teber MA, Tan S, et al. The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations. Med Ultrason 2014;6:304-308.
Jhaveri KS, Hosseini-Nik H, et al. The development and validation of magnetic resonance elastography for fibrosis staging in primary sclerosing cholangitis. Eur Radiol 2018 Jul 26.
Furukawa H, Takayasu K, et al. CT evaluation of small polypoid lesions of the gallbladder. Hepatogastroenterology 1995;42:800-810.
Elsayes KM, Oliveira EP, et al. Magnetic resonance imaging of the gallbladder: spectrum of abnormalities. Acta Radiol 2007;48:476-482.
Bilgin M, Shaikh F, et al. Magnetic resonance imaging of gallbladder and biliary system. Top Magn Reson Imaging 2009;20:31-42.
Lee J, Yun M, et al. Risk stratification of gallbladder polyps (1-2 cm) for surgical intervention with 18F-FDG PET/CT. J Nuclear Med 2012;53:353-358.
Nishiyama Y, Yamamoto Y, et al. Dual-time point 18F-FDG PET for the evaluation of gallbladder carcinoma. J Nucl Med 2006;47:633-638.
Shukla VK, Goel S, et al. Electrophoretic pattern of proteins in carcinoma of the gallbladder. Eur J Cancer Prev 2008;17:9-12.
Wang J, Zhang J, et al. Evaluation of gallbladder lipid level during carcinogenesis by an infrared spectroscopic method. Dig Dis Sci 2010;55:2670-2675.
Itsuki H, Serikawa M, et al. Indication and usefulness of bile juice cytology for diagnosis of gallbladder cancer. Gastroenterol Res Pract 2018;2018:5410349.
Itoi T, Sofuni A, et al. Preoperative diagnosis and management of thick-walled gallbladder based on bile cytology obtained by endoscopic transpapillary gallbladder drainage tube. Gastrointest Endosc 2006;64:512-519.
Hammoud GM, Almashhrawi A, et al. Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions. World J Gastrointest Oncol 2014;6:420-429.
Eelkema HH, Hodgeson JR, Fifteen-year follow-up of polypoid lesions of gallbladder diagnosed by cholecystography. Gastroenterology 1962;42:144-147.
Ukai K, Akita Y, et al. Cholesterol polyp of the gallbladder showing rapid growth and atypical changes–A Case Report. Hepatogastroenterology 1992;39:371-373.
Yamamoto M, Nakajo S, et al. Dysplasia of the gallbladder. Its histogenesis and correlation to gallbladder adenocarcinoma. Pathol Res Pract 1989;185:454-460.
Park JY, Hong SP, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 2009;24:219-222.
Bang S. Natural course and treatment strategy of gallbladder polyps. Korean J Gastroenterol 2009;53:336-340.
Z'graggen K, Birrer S, et al. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 1998;124:831-838.
Reddy YP, Sheridan WG. Port-site metastasis following laparoscopic cholecystectomy: a review of the literature and a case report. Eur J Surg Oncol 2000;26:95-98.
Cavallaro A, Piccolo G, et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg 2014;12:S108-S119.
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. NCCN. Available at https://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf Version 3. 2018 September 1, 2018.
Shih SP, Schulick RD, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007;245:893-901.
Mainprize KS, Gould SW, et al. Surgical management of polypoid lesions of the gallbladder. Br J Surg 2000;87:414-417.
Xu A, Zhang Y, et al. Gallbladder polypoid-lesions: what are they and how should they be treated? A Single-center experience based on 1446 cholecystectomy patients. J Gastrointest Surg 2017 Jul 10.
Boulton RA, Adams DH. Gallbladder polyps: when to wait and when to act. Lancet 1997;349:817.
Shirai Y, Sakata J, et al. Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes. World J Surg Oncol 2012;10:87.