Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2844
Peer-review started: March 29, 2018
First decision: May 16, 2018
Revised: May 23, 2018
Accepted: June 16, 2018
Article in press: June 16, 2018
Published online: July 14, 2018
A gallbladder polyp is an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps have an estimated prevalence in adults of between 0.3%-12.3%. However, only 5% of polyps are considered to be “true” gallbladder polyps, meaning that they are malignant or have malignant potential. The main radiological modality used for diagnosing and surveilling gallbladder polyps is transabdominal ultrasonography. However, evidence shows that other modalities such as endoscopic ultrasound may improve diagnostic accuracy. These are discussed in turn during the course of this review. Current guidelines recommend cholecystectomy for gallbladder polyps sized 10 mm and greater, although this threshold is lowered when other risk factors are identified. The evidence behind this practice is relatively low quality. This review identifies current gaps in the available evidence and highlights the necessity for further research to enable better decision making regarding which patients should undergo cholecystectomy, and/or radiological follow-up.
Core tip: Evidence for the optimum management of gallbladder polyps is lacking. The main imaging modality used for diagnosis and follow-up is transabdominal ultrasound, but some studies suggest improved accuracy with endoscopic ultrasound. Other imaging modalities lack evidence. Surgical management involves cholecystectomy and the general consensus is that polyps 10 mm and greater should undergo surgery. However, this is an arbitrary cut-off and high-quality evidence to support this is lacking. Lowering the threshold for cholecystectomy when patients have additional risk factors for gallbladder malignancy may improve the cancer detection rate in polyps smaller than 10 mm, but again, the evidence behind this is lacking.