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Polyp in gallbladder treatment. Gallbladder Polyps: Understanding Symptoms, Causes, and Treatment Options

by alexxlab

What are gallbladder polyps. How are they diagnosed. What symptoms can they cause. Are gallbladder polyps associated with cancer. What treatment options are available for gallbladder polyps.

What Are Gallbladder Polyps and How Common Are They?

Gallbladder polyps are abnormal tissue growths that can form within the gallbladder. These growths can vary in size and shape, with some appearing as small, flat bumps while others hang from tiny stalks. Research indicates that gallbladder polyps affect approximately 0.3–9.5% of the population, making them a relatively common occurrence.

There are three main types of gallbladder polyps:

  • Pseudopolyps (cholesterol polyps)
  • Inflammatory polyps
  • True gallbladder polyps

Understanding the differences between these types is crucial for proper diagnosis and treatment.

Pseudopolyps: The Most Common Type

Pseudopolyps, also known as cholesterol polyps, account for 60–90% of all gallbladder polyps. These noncancerous growths are filled with cholesterol and may indicate an underlying gallbladder issue, such as chronic cholecystitis (inflammation of the gallbladder). Pseudopolyps often develop when the gallbladder doesn’t empty properly.

Inflammatory Polyps: Signs of Gallbladder Wall Inflammation

Inflammatory polyps make up 5–10% of all gallbladder polyps. They are a sign of inflammation in the gallbladder wall and are commonly found in individuals who have experienced recurrent cholecystitis or acute biliary colic. Unlike true gallbladder polyps, inflammatory polyps are not associated with cancer risk.

True Gallbladder Polyps: Rare but Potentially Cancerous

True gallbladder polyps are the rarest type but carry the highest risk of becoming cancerous. These polyps typically measure between 5–20 millimeters in diameter. Any polyp larger than 1 centimeter (cm) has a higher likelihood of developing into cancer, which is why doctors may recommend gallbladder removal in such cases.

Symptoms and Diagnosis of Gallbladder Polyps

Can gallbladder polyps cause noticeable symptoms? In many cases, gallbladder polyps are asymptomatic, meaning they don’t cause any noticeable signs or discomfort. Doctors often discover these polyps incidentally during ultrasound or CT scans performed for other reasons.

However, when symptoms do occur, they may include:

  • Discomfort in the upper right side of the abdomen
  • Bloating
  • Nausea
  • Food intolerances

How are gallbladder polyps diagnosed? The primary methods for diagnosing gallbladder polyps include:

  1. Ultrasound imaging
  2. CT scans
  3. In some cases, a biopsy may be necessary to confirm the diagnosis

It’s important to note that while biopsies can provide valuable information, they also carry potential risks such as bleeding, infection, and bile leakage.

Risk Factors for Developing Gallbladder Polyps

Several factors can increase an individual’s likelihood of developing gallbladder polyps. These include:

  • High levels of cholesterol or salts in bile
  • Presence of gallstones
  • Familial polyposis (an inherited condition)
  • Gardner syndrome (a type of familial polyposis)
  • Peutz-Jeghers syndrome (a genetic condition)
  • Hepatitis B (acute or chronic viral infection)

Understanding these risk factors can help individuals and healthcare providers take appropriate preventive measures and ensure early detection of gallbladder polyps.

The Link Between Gallbladder Polyps and Cancer

Do all gallbladder polyps have the potential to become cancerous? No, the majority of gallbladder polyps (pseudopolyps and inflammatory polyps) are not associated with cancer. However, true gallbladder polyps do carry a risk of malignancy, particularly if they are larger than 1 cm in diameter.

Factors that may increase the risk of gallbladder cancer in individuals with polyps include:

  • Being over 50 years of age
  • Indian ethnicity
  • History of primary sclerosing cholangitis
  • Presence of a flat (sessile) polyp with thickening of the gallbladder wall

It’s crucial to understand that the overall risk of gallbladder cancer is relatively low. The 5-year survival rate for stage 1 gallbladder cancer is less than 50%, but fewer than 10% of cases are detected at this early stage. Regular monitoring and prompt treatment of gallbladder polyps can help reduce the risk of cancer development.

Treatment Options for Gallbladder Polyps

What are the available treatment options for gallbladder polyps? The appropriate treatment depends on several factors, including the size of the polyp, the presence of symptoms, and the individual’s overall health. Here are the main approaches:

Watchful Waiting and Monitoring

For small polyps (less than 1 cm) that don’t cause symptoms, doctors often recommend a watchful waiting approach. This involves regular monitoring through ultrasound or CT scans to track any changes in size or appearance of the polyps.

Gallbladder Removal (Cholecystectomy)

When is gallbladder removal necessary? Doctors may recommend cholecystectomy in the following cases:

  • Polyps larger than 1 cm in diameter
  • Rapid growth of polyps
  • Presence of symptoms
  • High risk of cancer based on other factors

Cholecystectomy is typically performed laparoscopically, which is a minimally invasive surgical technique that results in shorter recovery times and fewer complications compared to open surgery.

Lifestyle Changes and Management of Underlying Conditions

In some cases, addressing underlying health issues and making lifestyle changes can help manage gallbladder polyps. This may include:

  • Maintaining a healthy diet low in saturated fats
  • Managing cholesterol levels
  • Treating underlying conditions such as hepatitis B
  • Regular exercise and weight management

These approaches can help reduce the risk of polyp formation and progression, particularly in cases of cholesterol polyps.

Complications and Prognosis of Gallbladder Polyps

What complications can arise from gallbladder polyps? The majority of gallbladder polyps (pseudopolyps and inflammatory polyps) do not cause complications and are not associated with cancer. However, true gallbladder polyps carry a risk of developing into gallbladder cancer, which is the most significant potential complication.

Other possible complications include:

  • Obstruction of bile flow
  • Inflammation of the gallbladder (cholecystitis)
  • Risks associated with surgical removal, such as infection or bleeding

What is the long-term outlook for individuals with gallbladder polyps? The prognosis for most people with gallbladder polyps is excellent, especially when the polyps are small and asymptomatic. Regular monitoring and appropriate treatment when necessary can significantly reduce the risk of complications and ensure a good long-term outcome.

Prevention and Early Detection of Gallbladder Polyps

Can gallbladder polyps be prevented? While it’s not always possible to prevent gallbladder polyps, certain lifestyle choices and health practices may help reduce the risk:

  • Maintaining a healthy weight
  • Eating a balanced diet rich in fruits, vegetables, and whole grains
  • Limiting intake of saturated fats and cholesterol
  • Regular exercise
  • Managing underlying health conditions, such as diabetes or high cholesterol

How can early detection of gallbladder polyps be achieved? Regular check-ups and imaging studies, particularly for individuals at higher risk, can help in the early detection of gallbladder polyps. This includes:

  • Routine ultrasound examinations
  • Regular physical exams
  • Prompt investigation of any persistent abdominal symptoms

Early detection allows for timely intervention and reduces the risk of complications, including the development of gallbladder cancer.

Living with Gallbladder Polyps: Management and Quality of Life

How can individuals diagnosed with gallbladder polyps manage their condition and maintain a good quality of life? Living with gallbladder polyps often involves a combination of medical management and lifestyle adjustments:

Regular Monitoring

Adhering to scheduled follow-up appointments and imaging studies is crucial for tracking the progression of polyps and detecting any changes early.

Dietary Modifications

What dietary changes can help manage gallbladder polyps?

  • Reducing intake of high-fat and fried foods
  • Increasing consumption of fiber-rich foods
  • Staying hydrated
  • Eating smaller, more frequent meals to aid digestion

Stress Management

Chronic stress can exacerbate digestive issues. Implementing stress-reduction techniques such as meditation, yoga, or regular exercise can be beneficial.

Open Communication with Healthcare Providers

Maintaining open dialogue with doctors about any new symptoms or concerns is essential for optimal management of gallbladder polyps.

Support Groups and Education

Joining support groups or seeking educational resources can provide valuable information and emotional support for individuals living with gallbladder polyps.

By following these management strategies and working closely with healthcare providers, individuals with gallbladder polyps can often maintain a high quality of life and minimize the impact of their condition on daily activities.

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.

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.

Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives

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Surgery for gallbladder polyps

Surgery for gallbladder polyps

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Galimov O.V.

Department of Surgical Diseases and New Technologies with the course of the Institute of Additional Postgraduate Education of the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Department of Surgical Diseases and New Technologies with the course of the Institute of Additional Postgraduate Education of the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Bashkir State Medical University, Ministry of Health of Russia, Ufa, Russia

Lapteva K. V.

Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Surgical treatment of gallbladder polyps

Authors:

Galimov O.V., Khanov V.O., Baikov D.E., Lapteva K. IN.

More about the authors

Magazine:

Surgery. Journal them. N.I. Pirogov.

2020;(6): 49‑52

DOI:

10.17116/hirurgia202006149

How to quote:

Galimov O.V., Khanov V.O., Baikov D.E., Lapteva K.V. Surgical treatment of gallbladder polyps. Surgery. Journal them. N.I. Pirogov.
2020;(6):49-52.
Galimov OV, Khanov VO, Baykov DE, Lapteva KV. Surgical treatment of gallbladder polyps. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020;(6):49‑52. (In Russ.)
https://doi.org/10.17116/hirurgia202006149

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The experience of 42 laparoscopic cholecystectomy for diagnosed gallbladder polyps is presented. The data of additional research methods were analyzed, it was found that it is not possible to convincingly differentiate true and pseudopolyps, as well as benign, precancerous or malignant polyps preoperatively. At the same time, minimally invasive, video endoscopic technologies have enough opportunities for radical removal of gallbladder polyps during cholecystectomy.

Keywords:

gallbladder polyps

calculous cholecystitis

laparoscopic cholecystectomy

Authors:

Galimov O.V.

Department of Surgical Diseases and New Technologies with the course of the Institute of Additional Postgraduate Education of the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Department of Surgical Diseases and New Technologies with the course of the Institute of Additional Postgraduate Education of the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Baikov D.E.

Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia

Lapteva K.V.

Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of Russia, Ufa, Russia Treatment of gallbladder polyps. Modern problems of science and education. 2013;5:23-27. http://www.science-education.ru/ru/article/view?id=10221

  • Omorov R.A., Mundukov K.Zh. Diagnosis and treatment of gallbladder polyps. Vestnik AGIUV. 2013;1:49-50.
  • Terzi C, Sokmen S, Seckin S, et al. Polypoid lesions of the gallbladder: report 100 cases with special reference to operative indications. Surgery. 2000 June;127(6):622-627. https://doi.org/10.1067/msy.2000.105870
  • Wennmacker SZ, Lamberts MP, DiMartino M, Drenth JPH, Gurusamy KS. Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Systematic Review – Diagnostic . Version published: 15 August 2018. https://doi.org/10.1002/14651858.CD012233.pub2
  • Borisov A.E., Speaker B.V., Akimov V.P., Toidze V.V. Diagnosis and treatment of gallbladder polyps. Bulletin of St. Petersburg University. 2008;1:59-65. https://cyberleninka.ru/article/n/diagnostika-i-lechenie-polipov-zhelchnogo-puzyrya
  • Furukawa H, Kosuge T, Shiwada K. Small polypoid lesions of the helical computed tomography. Arch Surg . 1998 Jul;133(7):735-739.

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    Introduction

    Gallbladder polyposis (GBP) is a common disease, the detection of which has increased significantly in recent years [1-3]. Obviously, this is due to the improvement of the process of instrumental diagnostics. According to a Cochrane review (The Cochrane Library) by S.Z. Wennmacker (2018), in a general population of 1000 people, 6.4% of ultrasound examinations reveal gallbladder polyps [4].

    The increase in the incidence of pancreatic cancer is obviously due not only to an increase in the number of patients, but also to the improvement of diagnostic methods [2, 5, 6], in particular ultrasound, which contributes not only to the detection of polyps, but also to the description of various forms of gallbladder diseases. It is important that PZHP does not have distinct clinical manifestations, and complaints are mainly reduced to the manifestation of pain of varying intensity in the right hypochondrium. When an infection is attached, the clinic resembles acute cholecystitis. Despite the fact that the literature provides extensive information about ASF, many issues have not yet been resolved. First of all, these are questions about differential diagnosis and indications for surgical treatment. There are searches for more modern methods of diagnosis and justification of surgical treatment.

    Methods

    Currently, 2 methods are used to identify ASF and determine the type of polyps: transabdominal ultrasound (TAUS), which uses ultrasound to differentiate different types of tissue, and endoscopic ultrasound (EUS). At the same time, there is insufficient evidence that EUS has an advantage over TAUS in differentiating between true and pseudopolyps, as well as between benign and precancerous or malignant polyps [4]. It is not always possible to make a reliable diagnosis with small (up to 3-4 mm) polyp sizes and their localization in the area of ​​the gallbladder neck. CT scan can confirm the diagnosis.

    2015-2018 in the clinic of the Bashkir State Medical University, 42 patients (36 (85.7%) women, 6 (14.3%) men) with pancreas were operated on, all underwent laparoscopic cholecystectomy. The age of the patients varied from 27 to 73 years. In 41 (97.6%) cases, the operation was performed in a planned manner. In 1 (2.4%) case, the operation was performed on an emergency basis due to the development of acute cholecystitis. In 3 (7.1%) cases, the patients were operated on for cholelithiasis, chronic cholecystitis, but after the operation, along with gallstones, polyps were found in them. Gallstone disease was observed in only 38 (90.5%) of patients with PZHP.

    During the analysis of semiotics, no specific symptoms characteristic of this disease were found. As a rule, symptoms were observed that are most often detected in chronic cholecystitis. The leading symptom was pain in the right hypochondrium, often dull, and only in a few cases with localization of polyps in the region of the neck of the bladder and duct, the pain was paroxysmal in nature. Based on instrumental studies, it was found that more often polyps were localized in the body of the gallbladder, equally often polyps were located in the area of ​​the bottom and neck of the gallbladder. Polyps up to 3–4 mm in size were found in 4 (9.5%) of patients, from 5 to 10 mm – in 38 (90.5%). Single polyps were found in 37 (88.1%) patients, 2 or more polyps were found in 5 (11.9%) patients.

    In modern medical practice, a therapeutic tactic has taken root, in which the detection of a polyp leads to its elimination by surgery in the shortest possible time. This is due to the fact that adenomatous and hyperplastic polyps cause oncological alertness, since their malignant degeneration is potentially possible, and cholesterol polyps often cause inflammation of the gallbladder and pancreas. In addition, cases of rapid growth of polyps during dynamic observation are known, which indirectly affects the patient’s lifestyle and also contributes to an increase in surgical activity.

    Results

    After cholecystectomy, we visually confirmed the existence of a gallbladder polyp on a macropreparation, which was sent for histological examination in order to determine the type of neoplasm and verify the diagnosis. The most frequently found hyperplastic polyp – in 20 (47.6%) patients, adenomatous polyps were in 19 (45.3%), cholesterol – in 3 (7.1%), signs of chronic inflammation in the gallbladder wall were noted in all patients. the form of infiltration by lymphocytes and single histiocytes.

    We present a clinical observation of a patient with a giant gallbladder polyp associated with calculous cholecystitis. Patient M ., 66 years old, was admitted to the city hospital No. 3 of Ufa on December 9, 2018 on an emergency basis with complaints of paroxysmal pain in the right hypochondrium, nausea, and vomiting. Sick for 2 years, the last time the attacks of the disease became more frequent. TAUSI was performed, which revealed signs of acute calculous cholecystitis. EGDS revealed acute gastroduodenitis, and EUS revealed a tumor-like formation (1.5×1.5 cm) of the gallbladder. An additional examination using contrast-enhanced CT revealed that the gallbladder is located in a typically elongated, slightly curved shape, 47 × 22 × 21 mm in size, the bladder walls are not thickened (1–2 mm), homogeneous contents are in the lumen, with a density of 8 to 16 HU . In the area of ​​the bottom with spreading into the lumen of the bladder, a soft tissue formation of isodense density 15×16 mm in size is not clearly visualized, which does not deform the external outlines of the gallbladder. With amplification in all phases, the wall density increased uniformly from 35–45 to 85–95 HU in the arterial and venous phases of contrast enhancement and moderately decreased to 55-65 HU in the parenchymal, delayed phase of enhancement (Fig. 1, 2) . The density of formation in the lumen of the gallbladder changed in a similar way, corresponding to one or another phase of amplification, while the formation itself took on a more distinct shape.

    Fig. 1. CT image of the liver and gallbladder in the venous (portal) phase of enhancement. In the area of ​​the bottom of the gallbladder, spreading into the lumen of the organ and without deforming its external outlines, a soft tissue formation located near the wall of a rounded shape is determined, which evenly accumulates a contrast agent.
    Fig. 2. Computed tomogram of the liver and gallbladder in the sagittal projection in the venous (portal) amplification phase.

    Diagnosis: acute calculous cholecystitis (gall bladder tumor?). Cholecystectomy was performed (10.12.2018). Macropreparation: gallbladder 50×25×25 mm, its walls are moderately hyperemic, infiltrated, thick bile in the lumen, several calculi 3×3 mm in size, adenomatous polyp 1.6×1.6 cm in size in the bottom area (Fig. 3 , 4) .

    Fig. 3. Schematic representation of the gallbladder with a formation emanating from its wall and spreading into the lumen of the organ.
    Fig. 4. Gross specimen of the removed tumor – adenomatous polyp of the gallbladder (postoperative photograph).

    Histological conclusion: adenomatous polyp, consisting of many glands of various sizes and shapes, lined with columnar epithelium, which exhibits a certain degree of polymorphism, expressed both in separate areas of the polyp and in areas of the same gland, which indicates a different proliferative activity of the glands and their epithelium. The stroma of the polyp is heterogeneous, with a large number of vessels, saturated with edematous fluid with a high protein content, inflammatory infiltrates from lymphoid and histiocytic elements. The postoperative course was smooth, she was discharged from the clinic on the 3rd day with recovery.

    Conclusion

    Thus, gallbladder polyps are a common disease, often associated with gallstone disease and often cause inflammation of the gallbladder and pancreas, and also have the potential for malignant transformation, which leads to an increase in the frequency of indications for surgical treatment. Obviously, further studies are needed with clearly defined criteria for the diagnosis of gallbladder polyps, including criteria for identifying true polyps, as well as precancerous and malignant polyps.

    The authors declare no conflict of interest.

    

    Polyps of the gallbladder and their treatment

    Polyps of the gallbladder

    If we talk about polyps in general, polyps are a collective concept denoting pathological formations of various origin and essence. The main thing in this case is that these are benign growths on the mucous membrane. Polyps can be in any organ that has a mucous membrane, such as the stomach, intestines, uterus, bladder. For example, to understand what polyps look like in general, you can look at intestinal polyps:

    Gallbladder polyps are quite common. On average, they are present in 4-6% of the population. 80% of them occur in women over the age of 30 years.

    What are the polyps of the gallbladder.

    Four types of polyps are most common in the gallbladder.

    Cholesterol polyp – elevation of the gallbladder mucosa with cholesterol deposits.

    Inflammatory polyp – inflammatory reaction of the mucous membrane of the gallbladder in the form of growths of granulation tissue.

    Gallbladder adenoma – a benign tumor in the form of a polypoid growth of glandular tissue (see Fig.).

    Papilloma of the gallbladder – a benign tumor of the mucous membrane of the gallbladder in the form of papillary growths.

    Why are gallbladder polyps dangerous?

    By themselves, gallbladder polyps are not dangerous. The bad thing is that polyps can degenerate into malignant tumors, or cancer can be masked under the guise of a polyp. So, almost all authors dealing with this problem report a rather high percentage of malignant degeneration of polyps, even in asymptomatic cases. The percentage of such degeneration (malignancy) ranges from 10 to 33%.

    How do gallbladder polyps appear?

    There are no specific complaints in patients with gallbladder polyps. Often polyps do not show themselves at all. There may be discomfort in the right hypochondrium and epigastrium, poor tolerance to any type of food. Almost always, a gallbladder polyp is an incidental finding on ultrasound.

    How is gallbladder polyp diagnosed?

    As with other diseases of the gallbladder, ultrasonography plays a decisive role. At the same time, a certain rounded formation is detected in the gallbladder, associated with the wall of the bladder, and does not give an acoustic shadow.
    An interesting and probably promising method for diagnosing gallbladder polyps is endoscopic ultrasonography. At the same time, a long and flexible endoscope (similar to a gastroscope) has an ultrasonic sensor at the end. The patient swallows this device, then it is inserted into the duodenum, which, as you know, is close to the gallbladder. Because it uses much higher frequencies of ultrasound (7.5 to 12 megahertz compared to 2 to 5 megahertz in a standard study), endoscopic ultrasonography provides a high-quality image of even small structures, allows you to distinguish layers of the gallbladder wall.

    Treatment of gallbladder polyps

    The choice of treatment for your gallbladder polyp depends on a number of factors. Moreover, indications for surgery can be identified by contacting the operating surgeon, and not to other specialists.

    If we summarize the approaches proposed by various authors, we can focus on the following scheme when choosing a treatment.

    Polyps larger than 10 mm should be removed as they present a significant risk of malignancy or are already cancerous.

    Growing polyps should be removed. To determine whether polyps are growing, an ultrasound examination should be done on the same machine and by the same specialist with an interval of 6 months. Then control should be done once a year for life. If any of these follow-up studies reveals that the polyp is increasing in size, or there are changes in its blood supply, or other polyps appear, then one should be inclined towards surgery, and not live on a “powder keg” in anticipation of cancer.

    If the polyp does not have a stalk (polyp on a broad base), control should be done once every 3 months in the first year after its detection with a mandatory study of blood flow characteristics, and then 2 times a year. This is due to the fact that such polyps are more prone to malignant degeneration than pedunculated polyps. After 2-3 years, control studies are also carried out in a year for life. If the polyp begins to grow, then surgery is indicated.

    Another indication for cholecystectomy for polyps is their location in the neck of the gallbladder. In this case, they can be the background and cause of the development of acute inflammation with a violation of the outflow of bile from the gallbladder.

    What is the operation for gallbladder polyps.