Diagnosis and Management of Gallbladder Polyps

Abstract

Gallbladder cancer is a rather uncommon disease, when it gives symptoms it has usually reached an incurable stage. Therefore, every attempt must be made to find the asymptomatic stages and look for premalignant gallbladder polyps. Even if gallbladder cancer is a rare disease, gallbladder polyps are common, only a few polyps develop to cancer. This makes gallbladder polyps another problem: which are the polyps that must be surgically removed, which shall be followed-up, or for how long? The author used the keyword “gallbladder polypsn” in PubMed and reviewed the scientific literatures published from January 2000 to December 2011. The present review article has summarized almost all respects of gallbladder polyp, including the risk factors, clinical diagnosis and management, and comments made from the author, in which clinical treatments are recommended. It is author's purpose that the 11-year-knowledge about gallbladder polyps summarized from all worlds’ literatures is enough to know how clinicians will handle the next patient with gallbladder polyp.

The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations

“…Although most polyps are benign in nature, some early carcinomas show a similar appearance to benign polyps. Sonography has been used extensively in the pre-operative management of polyps, but this technique is generally not sufficient to differentiate between benign and malignant polyps, with the exception of advanced gallbladder cancer [18,19]. On the other hand, the overall prognosis for gallbladder cancer is extremely poor, with less than a 10% 5-year survival rate [6,20].…”

Endoscopic Ultrasonography (EUS) and Gallbladder

“…Adenomyomatosis of the gallbladder (GA) remains a common entity among benign gallbladder masses, diagnosed in 2-8% of all cholecystectomies in recent studies. The differentiation of GA from gallbladder cancer is still required because of the similarity in the appearance between gallbladder adenomyomatosis and gallbladder cancer, although many studies have reported imaging findings of adenomyomatosis of the gallbladder using US, computed tomography (CT), magnetic resonance imaging (MRI) and EUS [15,18,19].…”

“…The total EUS score on the basis of coefficient of multivariate analysis has been shown as follows: (maximum diameter in mm) + (internal echo pattern score; where heterogeneous = 4, homogeneous = 0) + (hyperechoic spot score; where presence = − 5, absence = 0). According to EUS scoring system, the specificity, sensitivity, and accuracy for the risk of malignant gallbladder polyps with scores of 12 or higher were reported for 83, 78, and 83%, respectively [4,15]. Proposed algorithm for management of gallbladder polyps is shown in Figure 4.…”

“…Other polypoid lesions include adenomyomatosis, adenoma, and adenocarcinoma. The poor prognosis of gallbladder carcinoma patients means it is important to differentiate between benign polyps and malignant or premalignant polyps [14,15].…”

“…Many of the signs and symptoms of gallbladder carcinoma are nonspecific, so it is more likely to be diagnosed at an advanced stage in patients and is associated with a high mortality rate. It is important the accurate preoperative staging ( Table 1) of gallbladder carcinoma, because staging is essential to determine the operative approach, and depth of invasion (T stage) closely correlates with prognosis [4,15].…”