NATURAL ORIFICE ENDOLUMINAL ENDOSCOPIC SURGERY (NOEES) FOR GALLBLADDER POLYPS: FEASIBILITY AND OUTCOMES OF A SINGLE-CENTER RETROSPECTIVE STUDY
Jian Guo Zhang11. Peking University, Beijing, Beijing, China.
Background: Gallbladder polyps ΓΆ"°Β¥1 cm in diameter are widely regarded as an indication for cholecystectomy worldwide because of their presumed malignant potential. However, final pathology shows that most polyps of this size are benign, implying that many patients may undergo unnecessary gallbladder removal. Natural Orifice Endoluminal Endoscopic Surgery (NOEES) is an innovative gallbladder-preserving approach to polyp resection that can avert cholecystectomy in selected cases. This study evaluated the feasibility, safety, and clinical outcomes of NOEES for the treatment of gallbladder polyps.
Methods: This single-center retrospective study included 20 consecutive patients with gallbladder polyps measuring 0.6â€"3.5 cm in diameter, confirmed by imaging. All patients underwent NOEES gallbladder polypectomy. Using a transoral natural-orifice route, the endoscope was advanced into the gallbladder lumen to resect the polyp while preserving the gallbladder. All procedures were performed by a single experienced endoscopist. Primary outcomes included procedural success (complete polyp removal), biopsy rate, postoperative pathological findings, and adverse events. Patients were followed for 6â€"26 months with clinical and imaging evaluations to monitor for polyp recurrence or delayed complications.
Results: The technical success rate of NOEES was 100% (20/20), and the biopsy rate was 100% (20/20). All target polyps were completely resected endoscopically with histologic sampling. There were no intraoperative conversions to open surgery and no procedure-related deaths. No patient developed severe post-procedural pancreatitis or other major complications. Histopathology revealed one case of high-grade intraepithelial neoplasia and one case of adenocarcinoma; the remaining 18 lesions were benign adenomas or cholesterol polyps. During the 6â€"26 month follow-up period, no polyp recurrence was observed, and all patients retained their gallbladder without biliary symptoms.
Conclusion: In this preliminary study, NOEES allowed minimally invasive resection of gallbladder polyps with gallbladder preservation and favorable clinical outcomes. In 90% (18/20) of cases, the resected polyps showed no malignancy, suggesting that routinely using polyps of this size as an indication for cholecystectomy may lead to unnecessary gallbladder removal. Our findings indicate that an endoscopic gallbladder-preserving approach is safe and feasible, challenging the widely accepted practice of recommending cholecystectomy for gallbladder polyps ΓΆ"°Β¥1 cm in diameter. NOEES may represent a paradigm shift toward gallbladder-preserving management of gallbladder polyps, but larger multi-center studies with longer follow-up are needed to validate these results.
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