Gallbladder Polyp – StatPearls – NCBI Bookshelf

Mark W. Jones; Jeffrey G. Deppen.

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Last Update: April 24, 2023.

Continuing Education Activity

Gallbladder polyps describe several conditions that present as projections into the gallbladder lumen. They may be asymptomatic, or they may be related to symptoms of cholecystitis (right upper abdominal discomfort, nausea and food intolerances). Often gallbladder polyps are found inadvertently on ultrasound or CT scanning or can be incidentally found on pathologic examination of the gallbladder. These polyps can be true neoplastic growths or pseudopolyps of cholesterol balls clinging to the wall of the gallbladder. This activity reviews the evaluation of gallbladder polyps and the role of the interprofessional team in managing this condition.

Objectives:

• Describe the expected signs and symptoms of gallbladder polyps.

• Discuss the frequency of gallbladder polyps.

• Outline the management of gallbladder polyps.

• This activity reviews the evaluation and treatment of gallbladder polyps and the role of the interprofessional team in evaluating and managing patients with this condition.

Access free multiple choice questions on this topic.

Introduction

Gallbladder polyps describe several conditions that present as projections into the gallbladder lumen. They may be asymptomatic, or they may be related to symptoms of cholecystitis (right upper abdominal discomfort, nausea and food intolerances). Often gallbladder polyps are found inadvertently on ultrasound or CT scanning or can be incidentally found on pathologic examination of the gallbladder. These polyps can be true neoplastic growths or pseudopolyps of cholesterol balls clinging to the wall of the gallbladder.

Etiology

There a few risk factors associated with true gallbladder polyp formation. Some studies suggest conditions such as familial polyposis, Peutz-Jeghers, Gardner syndrome, and hepatitis B may be factors associated with polyp formation. Pseudo or cholesterol polyps can develop when the cholesterol or bile salt content in the bile is high. This leads to condensation of cholesterol clumps which can adhere to the wall of the gallbladder. This condition may be a precursor to gallstone formation and can also at times be seen in conjunction with gallstones. Other factors typically associated with gallbladder diseases such as obesity, sex, weight loss, and diabetes have not been shown to increase the formation of gallbladder polyps. [1][2]

Epidemiology

Factors associated with an increased prevalence of gallbladder polyps is unclear. Studies have shown that 4% to 7% of the population may develop gallbladder polyps. The average age of diagnosis of gallbladder polyps is around 49 years old. However, other studies have found the presence of polyps to be more prevalent in older patients. [1][3]

Pathophysiology

The most common type of gallbladder polyps are pseudo or cholesterol polyps. These account for 60% to 90% of all gallbladder polyps. They are not true neoplastic growths, but rather they are cholesterol deposits that form as projections on the inner lumen of the gallbladder wall. They are formed from precipitation of cholesterol or bile salts. Presence of cholesterol polyps may be indicative of pathologic gallbladder disease such as chronic cholecystitis. Inflammatory polyps account for 5% to 10% of all gallbladder polyps. They are associated with inflammation of the gallbladder mucosa and wall. Usually, this type is associated with repeated bouts of cholecystitis and acute biliary colic. Both pseudopolyps and inflammatory polyps carry close to a zero risk of developing a gallbladder cancer. These polyps rarely exceed 1 cm in diameter and are often multiple. True adenomatous gallbladder polyps are considered neoplastic. They are rare and are often associated with gallstones. They can range in size from 5 mm to 20 mm. Once the polyp reaches a size of greater than 1 cm, consideration needs to be made for cholecystectomy, because of the potential malignant increases above 1 cm. Adenomyomatosis is a more common true poly. It has classically been considered a benign lesion of the fundus of the gallbladder. However, recent findings suggest these lesions do have premalignant potential. Malignant polyps tend to be singular and more than 2 cm in diameter. [4][5]

Histopathology

Two percent to 12% of routine gallbladder pathology specimens may contain gallbladder polyps, but true adenomatous polyps are present in less than 0.5% of all gallbladder specimens. Cholesterol polyps show an increased cholesterol content and are associated with gallbladder cholesterolosis and sludge. Inflammatory polyps exhibit inflammation of the gallbladder wall with Rotatinski- Aschoff bodies, and findings of acute or chronic cholecystitis. True adenomatous polyps have a glandular histology. Malignant polyps can demonstrate cancerous changes characteristic of adenocarcinoma, squamous cell carcinoma, and adenoacanthoma. The degree of malignant differentiation usually correlates to polyp size.  [6][7][8]

History and Physical

Most gallbladder polyps are asymptomatic. Patients with cholesterol stones related to hypokinetic gallbladder function, cholesterolosis, or stasis may exhibit symptoms of chronic cholecystitis. Right upper abdominal pain, food intolerance, bloating, and nausea may be present. Elicitation of a positive Murphy’s sign, pain with deep palpation to the right upper abdomen, is often present. Patients with larger adenomatous lesions may have more severe and persistent right upper abdominal pain. Cases of progressive polyps that have deteriorated into a malignancy may present with jaundice, due to growth and impingement of the common or hepatic bile duct. There may also be a palpable mass in the right upper abdomen. [9]

Evaluation

Gallbladder polyps are often found coincidentally with imaging such as an abdominal CT or an abdominal ultrasound. In cases of patients being worked up for gallbladder disease, the polyps are usually seen on abdominal ultrasound. They may present as a single lesion, or they may be multiple in nature. Polyps can occur in conjunction with gallstones but are often seen in the absence of stones. Differentiation must be made between gallstones and gallbladder polyps. Gallstones are usually mobile, and polyps are fixed to the wall of the gallbladder lumen. Most polyps are hypodense and smaller than 1 cm in diameter. They can appear polypoid or sessile. Singular polyps that have a tissue density and are larger than 1 cm in diameter carry a higher malignant potential. [10][11]

Treatment / Management

Gallbladder polyps that have the appearance of pseudo or cholesterol polyps, in asymptomatic patients, can be followed with yearly gallbladder ultrasounds. These patients have a very low malignant risk. If serial ultrasounds reveal that the polyp is enlarging or if the patient becomes symptomatic, then cholecystectomy should be recommended. Patients with symptoms of chronic cholecystitis are usually best treated with laparoscopic or open cholecystectomy. Polyps that are 1 cm or greater in size should undergo cholecystectomy due to the increased risk of developing gallbladder cancer. Early intervention is preferred because an early gallbladder neoplasm has a much higher rate of cure than a more advanced lesion. In fact, stage 0 gallbladder cancer has about an 80% 5-year survival rate, and stage 1 has less than a 50% survival rate. Less than 10% of all gallbladder cancers are diagnosed at stage 1 or lower. More advanced gallbladder cancers require an open cholecystectomy with resection of the gallbladder fossa of the liver along with regional lymph node removal. [12][13]

Differential Diagnosis

• Adenomyomatosis

• Biliary sludge

• Gallstones

• Tumefactive sludge

Pearls and Other Issues

The vast majority of gallbladder polyps are asymptomatic and carry a low risk of malignant degeneration. However, a small number of true gallbladder polyps will progress to malignancy. Patients with symptomatic gallbladder polyps or with enlarging polyps should be treated with cholecystectomy. The risks of performing a laparoscopic cholecystectomy are far less than missing a potential adenomatous polyp. It is recommended that if there is any indication of a gallbladder polyp being anything other than a pseudopolyp or cholesterol polyp, that cholecystectomy should be performed. [14][15]

Enhancing Healthcare Team Outcomes

Most true gallbladder polyps are not malignant. Often times they are not even true polyps and don’t need surgical intervention. A thorough understanding of the genesis and course of gallbladder polyps needs to held by the primary care physician and surgeon. Even though they may not exhibit any sign of malignancy or premalignancy, they must be followed. Yearly ultrasounds are noninvasive and will alert the following physician to enlargement, which would suggest the need for cholecystectomy. Delay in identifying such activity could jeopardize the patient and possibly lead to a missed newly developed cancer. If caught early, these neoplasms are curable. If caught late, then the prognosis is much more dismal.

Review Questions

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References

1.

Lee H, Kim K, Park I, Cho H, Gwak G, Yang K, Bae BN, Kim HJ, Kim YD. Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder. Ann Hepatobiliary Pancreat Surg. 2016 Nov;20(4):180-186. [PMC free article: PMC5325147] [PubMed: 28261697]

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Liu HW, Chen CY. Ovo-lactovegetarian diet as a possible protective factor against gallbladder polyps in Taiwan: A cross-sectional study. Ci Ji Yi Xue Za Zhi. 2019 Jan-Mar;31(1):29-34. [PMC free article: PMC6334569] [PubMed: 30692829]

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Torabi Sagvand B, Edwards K, Shen B. Frequency, Risk Factors, and Outcome of Gallbladder Polyps in Patients With Primary Sclerosing Cholangitis: A Case-Control Study. Hepatol Commun. 2018 Dec;2(12):1440-1445. [PMC free article: PMC6287476] [PubMed: 30556033]

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Sarici IS, Duzgun O. Gallbladder polypoid lesions >15mm as indicators of T1b gallbladder cancer risk. Arab J Gastroenterol. 2017 Sep;18(3):156-158. [PubMed: 28958638]

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Wu T, Sun Z, Jiang Y, Yu J, Chang C, Dong X, Yan S. Strategy for discriminating cholesterol and premalignancy in polypoid lesions of the gallbladder: a single-centre, retrospective cohort study. ANZ J Surg. 2019 Apr;89(4):388-392. [PubMed: 30497105]

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Esendağlı G, Akarca FG, Balcı S, Argon A, Erhan SŞ, Turhan N, Zengin Nİ, Keser SH, Çelik B, Bulut T, Abdullazade S, Erden E, Savaş B, Bostan T, Sağol Ö, Ağalar AA, Kepil N, Karslıoğlu Y, Günal A, Markoç F, Saka B, Özgün G, Özdamar ŞO, Bahadır B, Kaymaz E, Işık E, Ayhan S, Tunçel D, Yılmaz BÖ, Çelik S, Karabacak T, Seven İE, Çelikel ÇA, Gücin Z, Ekinci Ö, Akyol G. A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study. Turk Patoloji Derg. 2018;34(1):41-48. [PubMed: 28984336]

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An HJ, Lee W, Jeong CY. Primary Follicular Lymphoma of Gallbladder Presenting as Multiple Polyps. Clin Gastroenterol Hepatol. 2020 Jan;18(1):e5-e6. [PubMed: 30218702]

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Limaiem F, Sassi A, Talbi G, Bouraoui S, Mzabi S. Routine histopathological study of cholecystectomy specimens. Useful? A retrospective study of 1960 cases. Acta Gastroenterol Belg. 2017 Jul-Sep;80(3):365-370. [PubMed: 29560664]

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Chang KL, Estores DS. Upper Gastrointestinal Conditions: Gallbladder Conditions. FP Essent. 2017 Jul;458:33-38. [PubMed: 28682049]

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Sandrasegaran K, Menias CO. Imaging and Screening of Cancer of the Gallbladder and Bile Ducts. Radiol Clin North Am. 2017 Nov;55(6):1211-1222. [PubMed: 28991561]

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Kopf H, Schima W, Meng S. [Differential diagnosis of gallbladder abnormalities : Ultrasound, computed tomography, and magnetic resonance imaging]. Radiologe. 2019 Apr;59(4):328-337. [PubMed: 30789997]

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Xu A, Zhang Y, Hu H, Zhao G, Cai J, Huang A. 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 Nov;21(11):1804-1812. [PubMed: 28695432]

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Şahiner İT, Dolapçı M. When should gallbladder polyps be treated surgically? Adv Clin Exp Med. 2018 Dec;27(12):1697-1700. [PubMed: 30141282]

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Terzioğlu SG, Kılıç MÖ, Sapmaz A, Karaca AS. Predictive factors of neoplastic gallbladder polyps: Outcomes of 278 patients. Turk J Gastroenterol. 2017 May;28(3):202-206. [PubMed: 28316322]

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Li Y, Tejirian T, Collins JC. Gallbladder Polyps: Real or Imagined? Am Surg. 2018 Oct 01;84(10):1670-1674. [PubMed: 30747692]

Disclosure: Mark Jones declares no relevant financial relationships with ineligible companies.

Disclosure: Jeffrey Deppen declares no relevant financial relationships with ineligible companies.

Gallbladder polyps: Symptoms, causes, and treatments

Polyps in the gallbladder may not cause any symptoms. Depending on the type of polyps, they can be benign, be a sign of inflammation, or potentially lead to cancer.

Polyps are abnormal tissue growths.

Most people with gallbladder polyps do not experience symptoms. Doctors usually discover the polyps incidentally on ultrasound or CT scans.

Although some gallbladder polyps can develop into cancer, the vast majority of polyps are noncancerous. As long as the polyps are smaller than 1 centimeter (cm) in diameter and cause no symptoms, treatment is unnecessary.

This article discusses the symptoms and potential complications of gallbladder polyps. It also explains the association between gallbladder polyps and cancer and looks at the treatment options.

A polyp is an abnormal growth of tissue. Some polyps are small, flat bumps, while others hang from tiny stalks.

Polyps can form in various parts of the body, including the gallbladder. Researchers estimate that gallbladder polyps affect 0.3–9.5% of the population.

There are three main types of gallbladder polyps: pseudopolyps, inflammatory polyps, and true gallbladder polyps.

Pseudopolyps

Pseudopolyps, also known as cholesterol polyps, are the most common type, accounting for 60–90% of all gallbladder polyps. Pseudopolyps are noncancerous, cholesterol-filled growths.

Their presence sometimes indicates an underlying gallbladder issue, such as chronic cholecystitis. This is the term for gallbladder inflammation, which occurs when the gallbladder does not empty sufficiently.

Inflammatory polyps

Inflammatory polyps account for 5–10% of all gallbladder polyps. They indicate inflammation in the wall of the gallbladder.

Doctors usually find inflammatory polyps in people who have experienced cholecystitis more than once and those who have acute biliary colic. Biliary colic can occur when a gallstone blocks the duct of the gallbladder, and it typically results in pain after eating.

Inflammatory polyps are not associated with gallbladder cancer.

True gallbladder polyps

True gallbladder polyps are rare and have the potential to become cancerous.

These polyps typically measure 5–20 millimeters (mm) in diameter. Any that are larger than 1 cm are more likely to become cancerous.

When a person has larger polyps, the doctor may recommend removing the gallbladder.

Share on PinterestAn ultrasound view of the gallbladder showing a polyp inside it.
James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons

Gallbladder polyps do not always cause symptoms. In many cases, doctors find them unexpectedly on ultrasound or CT scans.

However, gallbladder polyps can sometimes cause the following symptoms:

• discomfort in the upper right side of the abdomen
• bloating
• nausea
• food intolerances

People with high levels of cholesterol or salts in their bile have an increased risk of developing gallbladder polyps. The liver produces bile and stores it in the gallbladder. The gallbladder’s main function is to help the body digest fat.

Gallbladder polyps are also associated with the formation of gallstones. Many people have both gallbladder polyps and gallstones.

The following health issues may increase a person’s risk of developing true gallbladder polyps:

• familial polyposis, an inherited condition
• Gardner syndrome, a type of familial polyposis
• Peutz-Jeghers syndrome, a genetic condition
• hepatitis B, a viral infection that can be acute or chronic

The majority of gallbladder polyps are pseudopolyps or inflammatory polyps. These do not cause complications and are not associated with cancer.

However, doctors regularly monitor all gallbladder polyps, regardless of their type. Removal of the gallbladder is only necessary if people experience symptoms or a polyp grows larger than 1 cm. The most significant complication of true gallbladder polyps is gallbladder cancer.

The biopsy procedure that doctors sometimes use to confirm the diagnosis can also potentially cause complications. These include bleeding, infection, and the leaking of bile.

Only true gallbladder polyps are associated with cancer. The stages of gallbladder cancer range from 0 to 5, with stage 5 being the most advanced.

The 5-year survival rate for stage 1 gallbladder cancer is less than 50%.

Doctors detect fewer than 10% of gallbladder cancer cases when they are at stage 0 or 1. They diagnose the majority of cancerous gallbladder polyps at a more advanced stage.

Factors that can increase a person’s risk of developing gallbladder cancer include:

• being over 50 years of age
• being of Indian ethnicity
• having a history of primary sclerosing cholangitis
• having a flat, or sessile, polyp, along with thickening of the gallbladder wall

Meanwhile, research indicates that people with pseudopolyps or inflammatory gallbladder polyps have almost no risk of developing gallbladder cancer.

Nonetheless, doctors monitor all gallbladder polyps closely. Those that grow larger than 1 cm have a higher likelihood of becoming cancerous. When a person has a polyp of this size, the doctor will advise removing the gallbladder.

Pseudopolyps and inflammatory polyps that are smaller than 1 cm and do not cause symptoms do not require treatment.

However, doctors routinely monitor all gallbladder polyps using ultrasound scans. The first scan usually takes place 6 months after the initial discovery of the polyp. Subsequent scans tend to occur at yearly intervals.

If a polyp has grown by 2 mm or more since the last checkup, the doctor will recommend the surgical removal of the gallbladder, which is called a cholecystectomy. There are two types: open cholecystectomy and laparoscopic cholecystectomy.

An open cholecystectomy involves the surgeon removing the gallbladder via a large incision under the right side of the rib cage. During a laparoscopic cholecystectomy, they will instead remove the gallbladder via small incisions in the abdomen.

Although gallbladder surgery typically has good outcomes, some possible complications include:

• bile duct injuries
• internal or external bleeding
• abscesses under the liver

Currently, the only treatment option for gallbladder polyps is the surgical removal of the gallbladder. However, as people with high cholesterol have an increased risk of developing cholesterol polyps, lowering cholesterol levels in the blood may help prevent cholesterol polyps from forming in the first place.

The American College of Cardiology and similar institutions recommend dietary changes for people with high cholesterol.

A low cholesterol diet includes plenty of the following foods:

• vegetables
• fruits
• whole grains
• legumes
• low fat dairy
• low fat poultry
• fish
• seafood
• nontropical vegetable oils

People with high cholesterol should also limit their intake of:

• sweets
• sugar-sweetened beverages
• red meats

Another way to lower cholesterol is through exercise. People should aim to exercise for a minimum of 40 minutes at least three times a week. The exercise should be aerobic and moderate to vigorous in intensity.

Some people may also need to take medication that lowers their cholesterol.

People with gallbladder polyps may not experience symptoms. Most gallbladder polyps are noncancerous, but they still require regular monitoring.

Surgery is necessary if polyps cause symptoms or are larger than 1 cm. Doctors also recommend surgery when a polyp has grown by 2 mm or more since the person’s last checkup.

True gallbladder polyps are rare, but they can cause gallbladder cancer. The standard treatment is the surgical removal of the gallbladder. Survival rates for people with this type of cancer are higher when doctors detect the cancer at an early stage.

Modern understanding of gallbladder polyps

What are gallbladder polyps?

A polyp of the gallbladder can be called any round formation, “growing” from the wall of the gallbladder and not like a stone.

What are gallbladder polyps?

All found polyps can be divided into “true” and “pseudo-polyps”.

True ones make up no more than 5% of all gallbladder polyps found on ultrasound and are essentially a tumor (that is, a neoplasm).

Pseudopolyps are any changes in the wall of the gallbladder that resemble a tumor (polyp) in their appearance, but are not inherently one. Up to 90% of gallbladder pseudopolyps are cholesterol polyps.

What are gallbladder cholesterol polyps and why do they occur?

Cholesterol polyps are rounded areas of accumulation of cholesterol in the mucous membrane of the gallbladder, and therefore they are referred to as pseudopolyps (that is, they are not a tumor), which means that they cannot become malignant (cannot degenerate into gallbladder cancer).

Cholesterol polyps appear as a result of excess cholesterol in the blood. The fact is that our body removes excess cholesterol from the blood with bile, which is able to dissolve it. But if there is too much cholesterol or the composition of bile is disturbed in a person (the content of bile acids in it is reduced or the ratio of their varieties is changed) – two options for further development of events are possible: – gallstone disease develops.

Which path the excess cholesterol will take in bile depends on its composition and dissolving power.

Why are polyps dangerous and why do you need to know about their existence?

Most polyps, including true ones, do not cause any symptoms. Complaints may appear already in the later stages, when a true polyp degenerates into gallbladder cancer. Therefore, if there are risks of polyps (listed below), it is important to check the condition of your gallbladder on ultrasound.

However, cholesterol polyps can sometimes be accompanied by discomfort or dull pain in the right hypochondrium, nausea, bloating, intolerance to fatty foods and other non-specific manifestations, but there is no exact understanding of why these symptoms occur (and whether they are associated with polyps) .

In addition, cholesterol polyps, as a rule, grow on the so-called “thin stalk”, from which they can tear off and block the bile ducts on the way out of the gallbladder. In this case, the situation is comparable to stone blockage in cholelithiasis – there is acute pain in the right hypochondrium, which may be accompanied by vomiting, fever, jaundice, the development of acute cholecystitis or pancreatitis. This situation may require calling an ambulance and even surgery.

Who is at higher risk for gallbladder polyps?

Based on the analysis of large studies, it was found that gallbladder polyps occur more often in persons:

1. Males (exception: cholesterol polyps, more common in multiparous women).
2. With obesity, concentrated in the abdomen.
3. CC with fatty hepatosis (moreover, the stronger the fatty liver, the larger the polyps in the gallbladder).
4. High diastolic pressure (diastolic pressure is your pressure when the heart is relaxed. It is also called “lower” pressure, and on the tonometer it displays the second number. If this number is 90 or higher – diastolic pressure can be considered high).
5. Patients with viral hepatitis B (positive blood test for HBsAg).

How can polyps be detected and monitored?

Abdominal ultrasonography can detect gallbladder polyps. If there is a need to examine the polyp better (for example, when the specialist is not completely sure whether it is a true polyp or pseudo, benign or malignant), you may be ordered to perform an endo-ultrasound (or EUS – endoscopic ultrasonography). Endo-ultrasound is performed in the same way as gastroscopy, only there is also an ultrasound sensor at the tip of the endoscopic apparatus. This study allows you to view the internal organs much closer – through the wall of the stomach and / or duodenum.

Your doctor will tell you how often you need to have a follow-up ultrasound. The frequency of observation depends on the initial size and appearance of the found polyps, as well as on the risks of their malignant transformation in each case.

Is it possible to “cure” gallbladder polyps?

Cholesterol pseudopolyps – yes. Treatment will include “washing out” cholesterol from the gallbladder wall, normalizing blood cholesterol levels, and dealing with conditions that increase the risk of polyps (overweight, high blood pressure, fatty liver, hepatitis B).

True polyps and some types of pseudopolyps can only be treated surgically, that is, by removing the gallbladder.

Who needs to remove the gallbladder if there are polyps in it?

It is necessary to remove the gallbladder in the following cases:

1. If a single polyp of 10 mm or more is found in the gallbladder during ultrasound; and also if, during the control ultrasound after 6 months, a single smaller polyp has grown by 2 mm or more.
2. If it is impossible to say with 100% certainty that the polyp is NOT cancerous.
3. If there is a risk of polyp degeneration into gallbladder cancer (the doctor determines according to the examination).
4. If there is concomitant cholelithiasis that caused 2 or more biliary colic, cholecystitis or pancreatitis.

Also consider removal of the gallbladder:

1. If there are many stones in the gallbladder that are more than 1/4 full.
2. In case of poor contractility of the gallbladder, determined by ultrasound of the gallbladder with a choleretic breakfast (ejection fraction less than 30%).
3. Failure to treat polyps with diet/drugs for 6-12 months.

If you are at risk of developing gallbladder polyps, we recommend that you have an abdominal ultrasound to rule out their presence. If, according to the results of ultrasound, you have found gallbladder polyps, be sure to consult a gastroenterologist: if true polyps are found that do not require surgical treatment, the doctor will tell you how often it is necessary to perform control ultrasounds and whether additional examination is needed, and if cholesterol polyps are found, he will be able to prescribe medication for you.

If you have indications for surgical treatment, remember that after removal of the gallbladder, the load on other organs of the gastrointestinal tract increases, therefore, the risk of exacerbation of chronic diseases of the digestive system that already existed before the operation increases, and it is also possible to develop new ones, such as postcholecystectomy syndrome. Our center has developed special programs that will help prevent possible complications of the operation, as well as maintain and improve the quality of life after cholecystectomy – the programs “Preparation for removal of the gallbladder” and “Rehabilitation after removal of the gallbladder”. If concomitant cholelithiasis is an indication for cholecystectomy, you can use the “Gallbladder Rescue with Stones” program, designed to treat gallstone disease without surgery.

Polyps in the gallbladder – what to do, how to treat, symptoms

What are polyps in the gallbladder

The gallbladder is a small, hollow organ located between the liver and stomach. Its purpose is to receive from the liver, concentrate (remove excess fluid) and store a supply of bile sufficient to dissolve a fatty meal. As soon as a person eats, for example, a cheburek, an eclair or a portion of grilled trout, the bladder releases the prepared bile into the small intestine. This allows you to effectively digest what you eat and avoid unpleasant sensations such as heaviness in the stomach.

The gallbladder is located between the liver and stomach

If the work of the gallbladder is disturbed for some reason, for example, due to cholelithiasis, inflammation or poor nutrition, polyps form. These are small benign neoplasms, which, as a rule, do not manifest themselves in any way: often the patient learns about them only during an examination for another disease.

According to the International Classification of Diseases ICD-10, a gallbladder polyp is assigned to code K82 (“Other diseases of the gallbladder”). In ICD-11, the pathology has the code DC10. 3 (“Polyp of the gallbladder”).

Why polyps occur in the gallbladder

There are several factors that most likely lead to the formation of a polyp in the gallbladder – these are long-term inflammatory processes, impaired bile outflow, changes in its composition and anatomical features of the structure of the organ, which are often hereditary.

Causes of polyps in the gallbladder:

• chronic inflammation: cholecystitis – inflammation of the gallbladder, cholangitis – inflammation of the gallbladder ducts;
• pathologies that violate the movement of bile: cholelithiasis, inflection of the gallbladder;
• high cholesterol in the body – hypercholesterolemia.

Polyps can form both in people with a hereditary predisposition to pathology, and in those who lead an unhealthy lifestyle.

Risk factors for the development of polyps in the gallbladder:

• heredity: if one of the parents is diagnosed with pathologies of the gallbladder that can lead to the development of polyps, their risk increases for the child;
• age: the risk of developing gallbladder polyps is higher in people over 50;
• weight: overweight people are more susceptible to pathology;
• smoking and alcohol abuse: irritates the mucous membrane of the gallbladder and increases the risk of polyps;
• low-quality products (containing nitrates and harmful food additives): negatively affect the condition of the mucous membrane of the digestive organs;
• poor nutrition (long breaks between meals, overeating, passion for fast food): leads to malfunctions of the gastrointestinal tract, impaired fat metabolism, changes in the properties of bile.

Overeating contributes to the appearance of polyps in the gallbladder

How common are polyps in the gallbladder

Typically, polyps are found in people with pathologies or structural features of the gallbladder – its inflection, gallstone disease, chronic inflammation.

Gallbladder polyps develop in about 7% of the population and are most common in people over 50 years of age.

Symptoms of polyps in the gallbladder

How polyps in the gallbladder manifest themselves depends on their number, size and location. In most cases – when polyps are small and located in a wide part of the organ – they do not cause any symptoms.

Small polyp located in the broad part of the gallbladder, usually not a problem

If a large polyp blocks the outflow of bile through the duct, symptoms similar to gallstone disease may occur. In this case, a person may feel heaviness in the abdomen, pain in the right hypochondrium. Stagnation of bile can cause nausea or vomiting, fever, and yellowing of the skin, mucous membranes, and whites of the eyes. Such a course is extremely rare.

What are polyps in the gallbladder

True polyps of the gallbladder are quite rare: up to 90% of all neoplasms in it are pseudopolyps – cholesterol deposits on the walls of the organ.

Pseudopolyps , or cholesterol polyps, are formed in violation of fat metabolism. Bile changes its characteristics: it becomes viscous, the concentration of cholesterol rises. Excess cholesterol is deposited on the walls of the gallbladder, forming outgrowths that look like polyps.

Such neoplasms do not degenerate into cancer.

True polyps are of several types. They have a different origin, composition and risk of transformation into a malignant tumor.

Types of true polyps of the gallbladder:

• infectious polyps – growths of the mucous membrane of the gallbladder that occur at the site of inflammation. The risk of developing cancer from such neoplasms is practically absent;
• hyperplastic polyps – growths of the mucous membrane of the gallbladder that occur with anomalies in the structure of the organ or against the background of non-infectious pathologies. The risk of malignancy is practically absent;
• adenomas (adenomyomatosis). These are benign tissue growths that have a low risk of malignancy. If the adenoma is not removed, it can transform into adenocarcinoma – a malignant formation that grows into the walls of the organ and destroys them.

Regardless of the type, gallbladder polyps are classified according to a number of criteria: prevalence, size, structure.

Types of polyps by prevalence:

• multiple – several neoplasms are formed at once, this is considered the most favorable option;
• single – such polyps are usually larger and have a greater risk of malignancy.

Types of polyps by size:

• small – up to 1 cm;
• large – more than 1 cm. Such polyps have a high risk of malignancy and must be removed.

Types of polyps by structure:

• with thin stem,
• with thick base (sitting).

How a polyp develops in the gallbladder

Infectious and hyperplastic polyps are formed with prolonged irritation of the mucous membrane and walls of the gallbladder (for example, in chronic or recurrent cholecystitis). The tissues in the affected area thicken, grow. A formation protruding above the surface of the mucous membrane is formed.

Neoplasms with a low risk of cancer usually do not grow more than 1 cm in diameter and often form in clusters.

Education mechanism adenomyoma has not been fully studied. It is assumed that they occur outside the inflammatory process, do not manifest themselves in any way and are detected by chance – during an examination for other pathologies of the gastrointestinal tract.

Stages of development of polyps in the gallbladder

If growth of a neoplasm is detected during diagnostic follow-up, it is highly likely that it is an adenomatous polyp. It has a risk of transformation into a malignant tumor, therefore it must be removed.

Development stages of adenomatous polyps:

• epithelial overgrowth – a small accumulation of cells;
• small adenomatous polyp;
• large adenomatous polyp;
• precancerous adenomatous polyp – malignant cells accumulate inside the polyp, but they do not interact with the walls of the gallbladder;
• adenocarcinoma is a malignant formation that originates from the cells of the mucous membrane that have undergone malignant degeneration, and, growing, gradually destroys the walls of the organ.

Diagnosis of polyps in the gallbladder

Examination of the gallbladder is indicated if there are characteristic symptoms (pain in the right hypochondrium, nausea, episodes of vomiting) or organ pathologies are diagnosed in close relatives.

An ultrasound is performed to determine the condition of the gallbladder. If a polyp-like tissue growth is detected during the study, further examination may be required, which includes computed or magnetic resonance imaging (CT, MRI).

During the diagnosis, the doctor may prescribe tests to assess the condition of the gallbladder and nearby organs: the liver and pancreas.

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Treatment of polyps in the gallbladder

Treatment is prescribed according to the results of the diagnosis: the method of therapy depends on the type of neoplasm, its size and whether it causes discomfort.

Indications for surgical treatment:

• polyp increases in size;
• polyp larger than 1 cm in diameter;
• polyp causes pain in the upper right side of the abdomen, nausea and other characteristic symptoms.

Large polyps (over 1 cm) are removed regardless of symptoms: there is a risk that such neoplasms transform into a malignant tumor. The operation is not recommended to be postponed: in the early stages, the volume of operated tissues is much smaller, and the prognosis is more optimistic.

Separately, polyps are not cut out: a complete cholecystectomy is performed, that is, removal of the gallbladder. Depending on the indications, abdominal or laparoscopic surgery is prescribed. During abdominal surgery, all manipulations are carried out through an open incision, and during laparoscopy, through several small punctures under the control of video endoscopy (a camera is inserted into one of the punctures and what is happening inside is broadcast on a monitor).

During surgical treatment, polyps are removed along with the gallbladder

With late diagnosis – if the neoplasm has become malignant – an abdominal operation is performed with the removal of the gallbladder and nearby lymph nodes.

Treatment of pseudopolyps

Pseudopolyps (cholesterol deposits on the mucous membrane of the gallbladder) do not lead to cancer, so their removal is not necessary. The doctor may prescribe drugs that improve the composition of bile and help reduce cholesterol plaque on the walls of the gallbladder. Patients with pseudopolyps are shown to visit a gastroenterologist annually and have an ultrasound scan of the gastrointestinal tract.

If the polyp grows or begins to cause discomfort or pain over time, surgical treatment is indicated.

Cholesterol polyps may detach from the gallbladder wall and obstruct the ducts – removal is also indicated in this case.

Prevention of polyps in the gallbladder

To avoid the formation of polyps, it is important to treat inflammation of the gastrointestinal tract in a timely manner, adhere to the principles of a healthy diet, and if symptoms occur (pain in the upper right part of the abdomen, nausea), consult a doctor.

Regular examinations are indicated if there are cases of gallbladder disease in the family: a predisposition to gallstone disease and polyps can be inherited.

In the prevention of diseases of the gallbladder, regular examination is of great importance. If a polyp or inflammation is detected in the early stages, treatment will be easier and more successful.

Which doctor to contact

Gallbladder polyps are treated by a gastroenterologist – a doctor who is responsible for the health of the digestive system. In the process of diagnosis, he will also check the functioning of the stomach, intestines, pancreas, liver, and if pathology is suspected, he will prescribe further examination and select therapy.

Complications of polyps in the gallbladder

If polyps form near the bile ducts, they can obstruct the flow of bile and cause inflammation of the gallbladder (cholecystitis), ducts (cholangitis), or pancreas (pancreatitis). The same consequences are possible if the polyp came off, got into the bile duct and blocked it.