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Gallbladder Polyps

Overview

Gallbladder polyps are growths or lesions that protrude from the lining of the gallbladder. Most are benign (non-cancerous), but some maybe malignant (cancerous), particularly larger ones.

  • Cholesterol polyps: These are the most common gallbladder polyps and are often associated with cholesterolosis. Cholesterol polyps are generally benign.
  • Adenomatous polyps: These are rue neoplasms with potential to become malignant (adenocarcinoma), and the cancer risk increases with size (>1 cm)
  • Inflammatory polyps: These occur in response to chronic inflammation, often in chronic cholecystitis.
  • Hyperplastic polyps: These are benign growths due to mucosal overgrowth, and generally, there is no cancer risk.
  • Adenomyomatosis: This entity refers to hyperplasia (overgrowth) of the gallbladder wall, not is considered a true polyp; however, it may mimic one.
  • Malignant polyps: These are rare and can progress to primary gallbladder carcinoma.

The causes and risk factors of gallbladder polyps have been enumerated below.

  • Accumulation of cholesterol and triglycerides in the gallbladder wall.
  • Chronic inflammation (chronic cholecystitis).
  • Abnormal cell growth due to genetic mutations (adenomatous polyps).
  • Association with gallstones and biliary sludge.

Risk factors

  • Individuals aged over 50 years of age are more prone to polyp development and men are at a higher malignancy risk.
  • Metabolic conditions:
    • Obesity
    • Dyslipidaemia
    • Metabolic syndrome
  • Gallbladder-related conditions:
    • Gallstones
    • Chronic gallbladder inflammation.
  • A family history of gallbladder cancer or polyps is a risk factor.

Many gallbladder polyps are asymptomatic and discovered incidentally. When symptoms occur, they may include:

  • Right upper quadrant pain
  • Nausea and vomiting
  • Bloating or indigestion
  • Jaundice (rare, may indicate obstruction or malignancy)

Various diagnostic modalities for gallbladder polyps have been enumerated below.

  • Imaging tests:
    • Ultrasound (first-line imaging): Ultrasound can detect polyps, measure polyp size, and assess gallbladder wall thickness.
    • Endoscopic ultrasound (EUS): Provides more detailed imaging, especially for small or suspicious polyps.
    • CT or MRI: Can evaluate larger polyps or suspected malignancy.
    • MRCP (magnetic resonance cholangiopancreatography): Can visualise the biliary tree and gallbladder.
  • Histological examination (if gallbladder is removed): Confirms the type of polyp and presence of cancer.

Various treatment modalities based on gallbladder polyp size have been enumerated below.

  • Small polyps (<1 cm, benign-looking): Regular follow-up with ultrasound every 6‒12 months. No treatment unless growth is detected or symptoms develop.
  • Larger polyps (>1 cm or suspicious features): Cholecystectomy (gallbladder removal): recommended due to increased malignancy risk.
  • Symptomatic polyps: Cholecystectomy is advised if symptoms like pain or inflammation occur.
  • Malignant polyps: Radical cholecystectomy may be needed, sometimes with additional liver resection or lymph node dissection if cancer is present.

Monitoring and Follow-Up

  • Polyps <6 mm with no risk factors may not need frequent follow-up.
  • Polyps 6-9 mm may require annual ultrasound monitoring.
  • Immediate surgical evaluation for polyps >1 cm.
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