Few studies have prospectively investigated the natural history of unresected gallbladder polyps. Eelkema et al reported no cases of gallbladder cancer in 113 patients fol-lowed-up for 15 years after the diagnosis of PLG on cholecystography. This study was limited, however, by the poor sensitivity of cholecystography in detecting PLG and, more importantly, by the loss to follow-up of half of the patients who were originally investigated. Moriguchi et al reported a similarly benign progression of gallbladder polyps. In that study, 109 patients with PLG were followed-up with serial ultrasounds every six to 12 months for at least five years. Gallbladder cancer was found in only one patient, but its location was different from that of the preexisting polyp. The size of most (84.5%) of the lesions did not change during the observation period. Only 16.7% of the largest lesions (those larger than 10 mm in diameter on the original ultrasound) enlarged. Shinkai and colleagues also reported no significant changes in the number or overall average size of cholesterol polyps in 60 patients followed-up sonographically for a mean of 22 months. During the follow-up period, nine patients underwent cholecystectomies; seven had histologically confirmed cholesterol polyps, one an adenoma and one a solitary dys-plastic lesion 2 mm in diameter. No patient developed adenocarcinoma of the gallbladder. A prospective German study, employing ultrasonographic examination of the gallbladder over a three-year period in 14,841 consecutive patients, revealed polypoid changes in 224 patients (1.5%). Of these, 95% were thought to be cholesterol polyps and the remainder were classified as benign lesions of uncertain etiology. During a short observation time of nine months, only 6.5% of the patients with cholesterol polyps had at least a 5 mm increase in the diameter of their polyps. A total of 21 patients suspected of having cholesterol polyps were operated on during this time. The diagnosis was confirmed in 17 patients; two had chronic cholecystitis and the remainder had other benign nonpoly-poid lesions. Of the 12 patients with benign polypoid lesions of uncertain etiology at the original ultrasonogram, six had cholecystectomies during the follow-up period. Surgical specimens revealed adenomas in two patients, gallbladder carcinoma in one, metastatic melanoma in one, ade-nomyomatosis in one and tissue heterotopy in one.
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Not all seemingly benign PLG, however, have demonstrated such slow growth. For example, Ukai et al reported a case of a cholesterol polyp that increased in diameter by 40% over a 10-month period. Such rapid growth has been suggested as an indication for surgery in patients with gallbladder polyps due to the concern of malignant transformation.