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Objectives: Gallbladder polyps are reported in 5% of screening ultrasonography (US). The majority are benign, however some do have a malignant potential. The preoperative confirmation of the nature of these lesions is "difficult" and the optimal management remains to be ill-defined
Aims: To determine the nature and assess the current clinical pathways for the ultrasound-detected gallbladder polyps (GBP) and propose a follow -up and a therapeutic strategy based on size and symptomatology
Methods: A retrospective search of the US database for "polyp" in gallbladder for the period between January 1st 2009 and Dec 31st 2010 was conducted. A database was then constructed including demographics, clinical presentation, principal symptoms, management and pathology. Histologic findings were analyzed in patients who underwent cholecystectomy. The electronic medical records were searched to check the clinical outcome, pathologic data and follow-up arrangements
Results: Ultrasound detected gallbladder polyps were reported in 347 patients, 214 female and 133 males with an age range between 14-93 yrs, (Median 5, IQR=41-58). Polyps were found during the course of investigation for the possibility of gallbladder disease in 125 patients (36%). The rest were incidental finding during investigation of other illnesses. The majority of referrals for the US came from primary care (60%), the rest came from hospital physicians in (24%) and surgeons in (13%) of cases. Forty two percent of the reports made no mention of polyp actual size and 39% reported the polypoid lesion to be <10mm without giving the actual size. The actual size was reported in only 12% of cases. Eighteen patients (5%) underwent laparoscopic cholecystectomy revealing neoplastic polyps (adenoma) in 2 cases and one case turned out to be invasive adenocarcinoma. Sixty six cases (19%) were under poorly defined surveillance and only 5 had follow up scans and more than 70% of the patients had no plans for follow up
Conclusion: Our preliminary data confirm that the majority of the US detected ‘polypoid lesions’ are incidental findings and are not true epithelial polyps. The majority of patients with symptomatic polyps who underwent cholecystectomy had cholelithiasis on histology. The current management strategy of asymptomatic polyps relies on its size and hence must be included in the US report which was poorly complied with in this series. Small (<10 mm) asymptomatic polyps need better characterisation by magnetic resonance imaging (MRI) and/or endoluminal ultrasound (EUS), while those > 10 mm should be offered cholecystectomy. A well defined long term follow up of patients is necessary to allow better understanding of this pathological entity and a nationwide registry or large longitudinal observational study is warranted as these might represent a missed opportunity for early detection of cancer