Polypoid lesions of the gallbladder

doi:10.1016/j.amjsurg.2003.11.043

The American Journal of Surgery

Volume 188, Issue 2, August 2004, Pages 186-190

https://doi.org/10.1016/j.amjsurg.2003.11.043 Get rights and content

Abstract

Background

Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinomas of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery, the operative approach, and the method of follow-up of those deemed not needing surgery.

Data sources

This review was done by Medline search of the English literature by the keywords “polypoid lesions of gallbladder,” “gallbladder polyps,” “carcinoma of gallbladder,” and “benign tumors of gallbladder.”

Conclusions

Most small polypoid lesions of the gallbladder are benign and remain static for years. Three- to six-monthly ultrasonography examination is warranted in the initial follow-up period but it is probably unnecessary after 1 or 2 years. Age more than 50 years and size of polyp more than 1 cm are the two most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstones, solitary polyp, and symptomatic polyp. Laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high, in which case it is advisable to have open exploration, intraoperative frozen section, and preparation for extended resection.

Section snippets

Patients and methods

A review is made here in an attempt to search for the latest understanding on definition, diagnosis, natural course, and management of PLG. A Medline search of the recently published English literature was made using the keywords “polypoid lesions of gallbladder,” “gallbladder polyps,” “carcinoma of gallbladder,” and “benign tumors of gallbladder.”

Treatment strategy

The main concern in the management of PLG is to identify and treat malignant lesions that are usually still at a relatively early stage and amendable to surgical cure. As mentioned earlier, the commonly reported rate of malignancy in PLG is around 3% to 8%. Obviously, operation will be overdone if cholecystectomy is offered to every patient with PLG. The issue is further complicated by the reliability of USG, which is usually the diagnostic tool used. The reported sensitivity and specificity of

Comments

Polypoid lesions of the gallbladder remain a problem of concern to both patients and surgeons. The importance of a thorough understanding of the underlying pathology and realization of limitation of USG in diagnosis cannot be overemphasized. The use of CT, EUS, and PET can be useful in selected cases for properly assessing and staging suspected malignancy.

In general, polyps larger than 1 cm and patient age more than 50 years are the two most important predictors for malignancy. Associated

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