What Causes Them and How Are They Treated?

Written by WebMD Editorial Contributors

• What Causes Gallbladder Polyps?
• Types of Gallbladder Polyps
• Symptoms of Gallbladder Polyps
• How Are Gallbladder Polyps Diagnosed?
• How Are Benign Gallbladder Polyps Treated?
• Risks for Malignant Gallbladder Polyps
• Recovering From Gallbladder Polyps
• More

Your gallbladder is a small organ that stores bile after your liver produces it and releases it into your small intestine. Bile contains salts, cholesterol, fat, and  pigments. Gallbladder polyps are abnormal growths that stick out from the lining of the inside of your gallbladder. In 95% of cases, these polyps are noncancerous.

It isn’t clear what causes gallbladder polyps. Your gallbladder is a pear-sized organ located beneath your liver. It stores and concentrates bile from your liver.‌

Your body uses bile to break down and absorb fat. Your gallbladder releases it into the first section of your small intestine. Bile contains bile salts, cholesterol, fat, and bile pigments.

There may be a connection between gallbladder polyps and the way your body breaks down fat. You may be more likely to get gallbladder polyps if your body doesn’t break down fat well.

Some proposed that polyps are a response to chronic inflammation of the gallbladder.

Gallbladder polyps are classified as benign or malignant. Benign means the polyp is noncancerous or not harmful on its own. Malignant means it is cancerous. There are several types of gallbladder polyps.‌

Cholesterolosis and pseudopolyps. Pseudopolyps are the most common type of gallbladder polyp. They are not true growths and don’t develop into cancer. They’re deposits of cholesterol caused by a condition called cholesterolosis. 

Pseudopolyps may indicate gallbladder disease such as chronic cholecystitis. Cholecystitis is an inflammation of your gallbladder.

Inflammatory polyps. Inflammatory polyps are often associated with inflammation of the gallbladder wall. These are often found in people who have had repeated episodes of cholecystitis and acute biliary colic. This happens when a gallstone blocks a bile duct. Inflammatory polyps don’t develop into cancer. 

Adenomatous polyps. These polyps are true tumors. They are rare and often occur in people who have had gallstones. They can range in size from 5 to 20 millimeters. Polyps larger than 1 centimeter have a greater chance of developing into cancer. ‌

Adenomyomatosis. This type of polyp is more common as you age. It’s considered a precancerous lesion. Only one of these polyps is usually found at a time.‌

Malignant polyps. This type of polyp is often larger than 2 centimeters in diameter. It is very rare. Again, only one is typically found. 

Gallbladder polyps often happen with no symptoms. They are usually found when your doctor does a computed tomography (CT) scan or ultrasound for another reason. There is no difference in the symptoms of benign and malignant polyps. The most common symptoms are:

• Nausea
• Vomiting
• Right upper abdominal pain
• Indigestion

Gallbladder polyps are often difficult to diagnose because there often aren’t any symptoms. If your doctor thinks you may have polyps, they may do an ultrasound.  

Treatment for benign polyps depends on the size of your polyp. Your doctor may just want to wait and follow up with regular ultrasounds for a small polyp that isn’t causing any symptoms.

Your doctor may recommend removing your gallbladder for a larger polyp or if you’re having symptoms. 

Malignant gallbladder polyps are rare. But some factors can increase your risk of them. These include:

• Being over the age of 50
• Having diabetes
• Size of your polyp
• Having gallstones
• Single polyp
• Having a polyp with symptoms

Gallbladder polyps are fairly common and usually benign. Your doctor may recommend that you simply follow up with ultrasounds to check for changes if you’re not experiencing any symptoms from them.

Your doctor will perform a surgery called a cholecystectomy if you need to have your gallbladder removed. It’s common and has a small risk of complications. You can usually go home the same day you have the surgery. But you may need to spend the night in the hospital. ‌

Cholecystectomies are usually done laparoscopically. This means they’re done with a small video camera and do not involve large incisions. Your doctor will make four small cuts in your abdomen and use a camera and special surgical tools to remove your gallbladder.  ‌

You may need an open cholecystectomy if your doctor can’t do the laparoscopic version. This involves one large incision and is far more invasive. It also has a greater risk of infection. You may need to spend 2 or 3 days in the hospital to recover.

Recovery from a laparoscopic cholecystectomy usually takes about 1 week. Full recovery from an open cholecystectomy can take 4 to 6 weeks.  

Top Picks

What Causes Them and How Are They Treated?

Written by WebMD Editorial Contributors

• What Causes Gallbladder Polyps?
• Types of Gallbladder Polyps
• Symptoms of Gallbladder Polyps
• How Are Gallbladder Polyps Diagnosed?
• How Are Benign Gallbladder Polyps Treated?
• Risks for Malignant Gallbladder Polyps
• Recovering From Gallbladder Polyps
• More

Your gallbladder is a small organ that stores bile after your liver produces it and releases it into your small intestine. Bile contains salts, cholesterol, fat, and  pigments. Gallbladder polyps are abnormal growths that stick out from the lining of the inside of your gallbladder. In 95% of cases, these polyps are noncancerous.

It isn’t clear what causes gallbladder polyps. Your gallbladder is a pear-sized organ located beneath your liver. It stores and concentrates bile from your liver.‌

Your body uses bile to break down and absorb fat. Your gallbladder releases it into the first section of your small intestine. Bile contains bile salts, cholesterol, fat, and bile pigments.

There may be a connection between gallbladder polyps and the way your body breaks down fat. You may be more likely to get gallbladder polyps if your body doesn’t break down fat well.

Some proposed that polyps are a response to chronic inflammation of the gallbladder.

Gallbladder polyps are classified as benign or malignant. Benign means the polyp is noncancerous or not harmful on its own. Malignant means it is cancerous. There are several types of gallbladder polyps.‌

Cholesterolosis and pseudopolyps. Pseudopolyps are the most common type of gallbladder polyp. They are not true growths and don’t develop into cancer. They’re deposits of cholesterol caused by a condition called cholesterolosis. 

Pseudopolyps may indicate gallbladder disease such as chronic cholecystitis. Cholecystitis is an inflammation of your gallbladder.

Inflammatory polyps. Inflammatory polyps are often associated with inflammation of the gallbladder wall. These are often found in people who have had repeated episodes of cholecystitis and acute biliary colic. This happens when a gallstone blocks a bile duct. Inflammatory polyps don’t develop into cancer. 

Adenomatous polyps. These polyps are true tumors. They are rare and often occur in people who have had gallstones. They can range in size from 5 to 20 millimeters. Polyps larger than 1 centimeter have a greater chance of developing into cancer. ‌

Adenomyomatosis. This type of polyp is more common as you age. It’s considered a precancerous lesion. Only one of these polyps is usually found at a time.‌

Malignant polyps. This type of polyp is often larger than 2 centimeters in diameter. It is very rare. Again, only one is typically found. 

Gallbladder polyps often happen with no symptoms. They are usually found when your doctor does a computed tomography (CT) scan or ultrasound for another reason. There is no difference in the symptoms of benign and malignant polyps. The most common symptoms are:

• Nausea
• Vomiting
• Right upper abdominal pain
• Indigestion

Gallbladder polyps are often difficult to diagnose because there often aren’t any symptoms. If your doctor thinks you may have polyps, they may do an ultrasound.  

Treatment for benign polyps depends on the size of your polyp. Your doctor may just want to wait and follow up with regular ultrasounds for a small polyp that isn’t causing any symptoms.

Your doctor may recommend removing your gallbladder for a larger polyp or if you’re having symptoms. 

Malignant gallbladder polyps are rare. But some factors can increase your risk of them. These include:

• Being over the age of 50
• Having diabetes
• Size of your polyp
• Having gallstones
• Single polyp
• Having a polyp with symptoms

Gallbladder polyps are fairly common and usually benign. Your doctor may recommend that you simply follow up with ultrasounds to check for changes if you’re not experiencing any symptoms from them.

Your doctor will perform a surgery called a cholecystectomy if you need to have your gallbladder removed. It’s common and has a small risk of complications. You can usually go home the same day you have the surgery. But you may need to spend the night in the hospital. ‌

Cholecystectomies are usually done laparoscopically. This means they’re done with a small video camera and do not involve large incisions. Your doctor will make four small cuts in your abdomen and use a camera and special surgical tools to remove your gallbladder.  ‌

You may need an open cholecystectomy if your doctor can’t do the laparoscopic version. This involves one large incision and is far more invasive. It also has a greater risk of infection. You may need to spend 2 or 3 days in the hospital to recover.

Recovery from a laparoscopic cholecystectomy usually takes about 1 week. Full recovery from an open cholecystectomy can take 4 to 6 weeks.  

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Polyps of the gallbladder.

What are gallbladder polyps?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Gallbladder polyps are true benign tumors or pseudotumor formations originating from the gallbladder epithelium. Almost 2/3 of the cases are asymptomatic. May be manifested by dull pains or colic in the right hypochondrium, dyspepsia, a progressive deterioration in general well-being. They are diagnosed using sonography of the gallbladder, ERCP, duodenal sounding, bile analysis, histological examination. Antibiotics, choleretics, cholekinetics, antispasmodics, cheno- and ursodeoxycholic acid are used for conservative therapy of pseudopolyps. True polyps are removed during open or laparoscopic cholecystectomy.

ICD-10

D37. 6 Liver, gallbladder and bile ducts

• Causes
• Pathogenesis
• Classification
• Symptoms
• Complications
• Diagnostics
• Treatment of gallbladder polyps
• Prognosis and prevention
• Prices for treatment

General

The prevalence of gallbladder polyps in the population is 1.5-9.5%. In women, polyposis of the gallbladder occurs 4 times more often than in men. True and pseudopolyps growing into the lumen of the gallbladder are usually detected after 30-35 years; polypoid formations rarely occur in children. In male patients, polypous cholesterosis predominates, in women, adenomatous and papillomatous growths occur relatively more often. The relevance of timely detection of polyps, determination of their morphological type and choice of optimal medical tactics is due to the long asymptomatic course of the disease and the high risk of malignancy of true neoplasms.

Gallbladder polyps

Causes

Gallbladder polyposis is a polyetiological disease, mainly associated with the impact of various irritating factors on the gallbladder mucosa. In some patients, the disease has a genetic origin. Specialists in the field of modern gastroenterology and hepatology distinguish three main groups of causes that contribute to the formation of gallbladder polyps:

• Burdened heredity and disembryogenesis. The risk of formation of polyposis formations increases in the presence of gallbladder polyposis in the genus. Adenomas and papillomas of the gallbladder are usually inherited. Intrauterine gene mutations that occur under the influence of viruses, radiation, embryo- and fetotoxic chemicals can play a certain role.
• Hepatobiliary pathology. Most often, polyps are formed against the background of chronic cholecystitis, accompanied by stagnation of bile, thickening and deformation of the wall, persistence in the cavity of the gallbladder of pathogenic and opportunistic infectious agents. The development of the disease is also facilitated by cholangitis, cholecystocholangitis, biliary dyskinesia.
• Metabolic disorders. With lipid metabolism disorders and an increase in the serum concentration of cholesterol in the walls of the gallbladder, cholesterol pseudopolyps are formed. The deposition of excess cholesterol in the gallbladder mucosa is also possible with an increase in its content in bile in patients with cholelithiasis, opisthorchiasis and other helminthic invasions.

Pathogenesis

The mechanism of formation of gallbladder polyps is determined by the type of volumetric formations and the causes that caused the disease. The pathogenesis of true benign tumors (polyps, adenomas) is presumably based on a violation of the mechanisms that control the division, growth, programmed death of prismatic and basal gallbladder epitheliocytes. The result of epithelial hyperplasia is the formation of slowly growing adenomatous and papillomatous polyps without signs of cellular atypia.

Inflammatory pseudopolyps are granulomas resulting from the proliferation and transformation of phagocytic cells. Pseudotumor formation is formed in stages with infiltration of the mucous layer of the gallbladder by young monocytic phagocytes, which mature into macrophages and subsequently transform into epithelioid cells. The development of cholesterol tumor-like formations is based on the deposition of excess cholesterol under the epithelial membrane, which can calcify over time.

Classification

The systematization of the clinical forms of the disease is carried out taking into account the location of polyps, their number and morphological features. Polyposis growths are single and multiple. By localization, there are asymptomatic polyps of the body, the bottom of the gallbladder and clinically pronounced polyp-like growths of the neck of the organ, cystic duct. Taking into account the histological structure, there are:

• Cholesterol pseudopolyps are tumor-like formations represented by cholesterol deposits under the gallbladder mucosa. According to various sources, they are found in 87-95%, can resolve after conservative therapy.
• Inflammatory pseudopolyps – granulomatous growths of the epithelial layer as a result of the accumulation of phagocytic cells and reactive hyperplasia of the epithelium. Regression after anti-inflammatory therapy is possible.
• True polyps are adenomas formed by hyperplastic glandular epithelium and papillomas represented by papillary growths. For small tumors, observation is recommended; large and rapidly growing polyps must be removed along with the gallbladder.

Symptoms

The disease can proceed for a long time without clinical manifestations. The severity of symptoms mainly depends on the location of the gallbladder polyps. Most often, the only symptom of the disease is periodic dull pain in the right hypochondrium, which occurs regardless of food intake. Less commonly, patients complain of intense soreness in the projection of the organ, aggravated after physical exertion or eating fatty foods. Some patients may experience severe paroxysmal pain, resembling biliary colic.

With gallbladder polyps, dyspeptic disorders are also observed: bitterness in the mouth, belching, nausea. Sometimes there is vomiting with an admixture of bile. With a long course of the disease, a deterioration in the general condition is noted: a decrease in appetite, constant weakness, a decrease in tolerance to physical exertion. With the localization of polyps in the region of the neck of the gallbladder, the symptoms may resemble acute cholecystitis – sharp pains are accompanied by fever, nausea and vomiting.

Complications

Obturation of the gallbladder with polyps contributes to the violation of the outflow of bile and the active reproduction of pathogenic microflora, infection of the contents of the organ, the development of acute cholangitis and cholecystitis. Without treatment, this condition can provoke the occurrence of empyema of the gallbladder, its perforation with the release of pus into the peritoneal cavity and biliary peritonitis. The concomitant increase in pressure in the choledochus is accompanied by the throwing of bile into the common pancreatic duct, which increases the likelihood of chronic pancreatitis.

Polyposis formations can increase in size and clog the common bile duct, which leads to obstructive jaundice. At the same time, patients experience icteric staining of the sclera and mucous membranes, skin itching, pain on palpation of the liver. The ingestion of a large number of bile components into the blood (cholemia) is characterized by endotoxemia syndrome, a decrease in the filtration capacity of the kidneys, and a violation of the permeability of the blood-brain barrier. In 10-30% of cases, true gallbladder polyps become malignant.

Diagnostics

Diagnosis without instrumental examination data is difficult, since gallbladder polyposis does not have pathognomonic clinical symptoms. It is necessary to suspect the disease in the presence of chronic complaints from the biliary system and the absence of characteristic signs of cholelithiasis. The most informative in the diagnostic plan are such research methods as:

• Ultrasound examination of the gallbladder. Sonography is the main method of rapid diagnosis of the disease. During ultrasound of the gallbladder, rounded formations with clear contours, thickening and swelling of the walls of the organ are revealed. The method does not allow detecting small polyps (up to 5 mm).
• RKhPG. The introduction of a flexible endoscope helps to assess the state of the sphincter of Oddi, to examine the large bile ducts. During subsequent retrograde cholangiopancreatography with filling of the biliary system with a contrast agent, polyps are visualized as round filling defects.
• Duodenal sounding. Sequential sampling of several fractions of bile through a probe is performed to assess the functional state of the gallbladder. A small amount of bile from portions B and C obtained by duodenal sounding is used for biochemical and bacteriological analysis.
• Study of bile. With complications of polyps, the density of bile increases, the pH reaction shifts to the acid side. Microscopically, a high content of leukocytes, mucus and epitheliocytes is determined. Bakposev confirms concomitant cholecystitis (bacteria level of 107 CFU/ml is predictively significant).
• Histological analysis. The study of the tissue structure of formations under a microscope is carried out after their surgical or endoscopic removal to confirm the benign nature of the disease. During the histological examination, the morphological type of the polyp is specified.

In the general blood test, all indicators are usually within the normal range, during the period of exacerbation of the disease, moderate leukocytosis is possible. Characteristic changes in the biochemical analysis of blood are an increase in the level of transaminases (AST and ALT), a slight decrease in total protein. With difficulties in diagnosis, CT is performed for detailed visualization of the gallbladder.

First of all, polyps must be differentiated from chronic cholecystitis. The main diagnostic finding, which testifies in favor of polyposis, is the detection of rounded formations in the gallbladder by ultrasound. In case of exacerbation, differential diagnosis is carried out with acute surgical pathology. The patient is examined by a gastroenterologist, a hepatologist, with an unclear etiology of formations, an oncologist’s consultation is necessary.

Treatment of gallbladder polyps

When choosing a method of therapy, the type of volumetric formation is taken into account. Patients with inflammatory granulomatous pseudopolyps are usually recommended medical treatment of chronic cholecystitis with antibiotics, antispasmodics, choleretics and cholekinetics. In the presence of the most common cholesterol polyps, the administration of ursodeoxycholic and chenodeoxycholic acid preparations is effective, which stimulate the formation of bile and improve its qualitative composition, contributing to the dissolution of cholesterol accumulations.

Conservative treatments for true gallbladder polyps have not been proposed. Patients with solitary benign tumors up to 10 mm in size are subject to dynamic observation with ultrasound every six months if a pedunculated mass is detected and once a quarter if a polyp with a wide base is detected. If multiple neoplasms without a stem are found, the size of the tumor is more than 10 mm or its increase is more than 2 mm per year, removal of the gallbladder is indicated. Taking into account the clinical situation, the following is performed:

• Minimally invasive interventions. The most commonly performed laparoscopic cholecystectomy, which minimizes traumatic injuries when removing the gallbladder along with polyps. In recent years, single-port SILS cholecystectomy with access to the organ through a single mini-incision in the umbilical region has become very popular.
• Classic operations. With a combination of true polyps with complicated cholelithiasis or the occurrence of complications during laparoscopic interventions, open cholecystectomy is indicated. In patients with previous abdominal operations, severe comorbidity, the gallbladder can be removed from the mini-access.

Prognosis and prevention

The outcome of the disease depends on the location and size of the polyps, as well as on the timeliness of the treatment started. In patients with single formations up to 1 cm in diameter, the prognosis is favorable. Prognostically unfavorable is the age over 65 years, multiple polyps of the neck of the bladder and bile duct, the presence of calculi. Measures of specific prevention of the disease have not been developed. To prevent complications, it is necessary to carefully examine patients with pathology of the biliary tract and conduct complex treatment.

You can share your medical history, what helped you in the treatment of gallbladder polyps.

Sources

1. Diagnosis and treatment of benign gallbladder polypoids. Abstract of the dissertation / Speaker B. V. – 2009.
2. Treatment of gallbladder polyps/ Mundukov K.Zh.// Modern problems of science and education. — 2013 — № 5.
3. Diagnosis and treatment of gallbladder polyps / Omorov R.A., Mundukov K.Zh. // Bulletin of the Almaty State Institute for the Improvement of Doctors. – 2013 – No. 1.
4. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Gallbladder polyp: causes, symptoms and recommendations for the treatment of the disease. Dr. Peter

• Directory of Diseases

December 26, 2022

Gallbladder polyps are, in most cases, benign neoplasms that in many cases are completely asymptomatic and therefore often detected by chance during ultrasound examination.

Source:

iStockphoto

Small lesions usually do not require treatment but should be checked regularly with ultrasound. However, for findings larger than ten millimeters, (usually laparoscopic) removal of the entire gallbladder is recommended because larger gallbladder polyps carry a rare risk of developing into carcinoma.

Gallbladder polyps often remain asymptomatic or cause gallstone-like symptoms. These are benign neoplasms in the gallbladder, which in rare cases can also become malignant. Gallbladder outgrowths often contain cholesterol in addition to mucosal cells, making it difficult to distinguish them from stones on sonographic diagnosis.

They usually only become medically significant when they are about ten millimeters in size or tend to grow rapidly. In these cases, due to the risk (albeit extremely rare) of degeneration into carcinoma, a decision will be made to remove the entire organ as a precautionary measure, followed by a histological examination of the tissue.

Causes

Approximately one in 20 people will experience this problem at some point in their lives. And men are much more likely than women. One of the main reasons for the formation of a gallbladder polyp, like stones, is an increased content of cholesterol in bile. In addition to deposits on the lining of the gallbladder (cholesteatosis), it also causes mucosal bulges containing cholesterol, which form cholesterol polyps. Interestingly, the joint formation of stones and polyps in the same organ almost never occurs – in most patients, only one of the two structures is diagnostically present.

Since in both cases an excess of cholesterol leads to development, malnutrition should also be considered as the root cause. Other growths in the gallbladder can also contribute to the formation of polyps. As a rule, these are benign adenomas that develop either from the mucous membrane or from glandular tissue (cystadenomas) and contribute to the development of polyps.

Symptoms of a gallbladder polyp

Whether polyps cause any symptoms depends on the size of the elements and the stage of development of the disease. Isolated polyps of the gallbladder often do not show any complaints. However, when they occur in connection with other diseases, nausea, vomiting, pain in the right upper abdomen radiating to the shoulder girdle, a feeling of fullness, flatulence and colic may occur. These are complaints that can also occur with stones.

If a large element is formed, the bile ducts and blood supply may also be blocked. The blockage leads to jaundice, which is characterized by yellowing of the skin and eyes. In addition, there is excruciating itching and fatigue. The functioning of the liver can be so impaired that its detoxification function stops working. Gradually, toxic metabolic products accumulate in the body. After removal of the affected gallbladder, the symptoms usually disappear completely. At the same time, it also eliminates the risk of polyps turning into gallbladder cancer.

Possible complications and risks

Usually the elements themselves do not cause discomfort, pain or complications. For this reason, they go unnoticed for a very long time and in most cases are diagnosed by chance. However, they can lead to pain or nausea associated with other gallbladder diseases. Digestive problems and diarrhea are a common reason for examination. In some cases, jaundice occurs.

If the lesions are relatively small and do not cause discomfort or pain, they are usually not removed. There are no further complications for the patient, and polyps do not lead to subsequent damage. However, if they are large, spreading and growing, in most cases the entire gallbladder needs to be removed. It also reduces the risk of cancer.

Diagnosis

Gallbladder polyps are diagnosed by ultrasound, although the difference between cholesterol-containing polyps and stones is not always clear due to their similar appearance on ultrasound. It is also possible not to notice the growths if they are very small, or they cannot be differentiated from the surrounding tissue structures. Some laboratory values ​​(gamma-HT, alkaline phosphatase) may also increase the suspicion that there is a problem in the gallbladder.

How to treat a gallbladder polyp

Small and asymptomatic gallbladder polyps can be left without further treatment with regular ultrasound monitoring. If the gallbladder grows rapidly and is larger than ten millimeters, it should be completely removed surgically (cholecystectomy). In uncomplicated cases, this is usually done very carefully as part of a laparoscopy.

In the case of symptoms such as frequent indigestion, chronic fatigue or sudden weight loss, degeneration into a precancerous stage or carcinoma should also be considered, despite its relatively rare occurrence. If there is a suspicion of a progressive disease, a laparotomy is an open operation.

Prophylaxis

No specific form of prophylaxis known. However, since some polyps contain cholesterol, as is the case with stones, a healthy diet can have a beneficial effect, at least by lowering cholesterol in bile. There is an important method of prevention regarding the possible degeneration of polyps into carcinoma: if small polyps have already been diagnosed, they should be checked regularly.