Gallbladder polyps are common in the adult population. The majority of PLG are cholesterol polyps; thus, most PLG have a low malignant potential. We suggest resection of polyps in patients with compatible symptoms, including biliary-type pain and dyspepsia. In addition, asymptomatic individuals older than 50 years of age or those whose polyps are solitary, greater than 10 mm in size, associated with gallstones, or growth on serial ultrasonography, should undergo resection (Table 2). The true malignant risk that is conferred by lesions being sessile or associated with wall thickening remains unclear. Further studies are necessary to define the impact of these possible risk factors before modification of the existing resection criteria should be considered. Furthermore, the role of novel diagnostic techniques, such as enhanced CT scanning, EUS and percutaneous fine needle aspiration, in assessing gallbladder polyps needs to be defined before their broad dissemination in the management of these lesions. Larger prospective studies of diagnosis and treatment must also be carried out in European and North American populations that have a lower risk of gallbladder cancer than most Asian countries because extrapolation of data from the latter may not be appropriate.
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Important features of polypoid lesions of the gallbladder
|Pathology||Most commonly (approximately two-thirds) cholesterol polyps. Other lesions include adenomas, inflammatory polyps, leiomyomas and gallbladder adenocarcinoma.|
|Prevalence||0.32% to 6.9%.|
|Risk factors||No consistent patient profile. Advancing age may be important, but obesity, female sex and diabetes mellitus (the typical gallstone phenotype) are unimportant.|
|Symptoms||Most are asymptomatic, but symptoms include right upper quadrant or epigastric pain, nausea and vomiting.|
|Ultrasonography||Immobile, hyperechoic shadows protruding into the gallbladder lumen. Sensitivity ranges from 32% to 90%, with a specificity of up to 94% (sensitivity is decreased in the presence of gallstones). Endoscopic ultrasonography appears to be more sensitive and may have a role in difficult cases.|
|Natural history||The majority do not grow; however, rapid growth has been reported. Overall, the malignant potential appears low, but several factors increase the risk of malignant transformation.|
|Treatment||Consider cholecystectomy in those with symptoms, large lesions (>10 mm in diameter) or features associated with malignancy (Figure 3).|