Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis

Cândia, Roberto; Viñuela, Macarena; Chahuán, Javier; Díaz, Luis Antonio; Gandara, Vicente; Errázuriz, Pedro; Bustamante, Luis; Villalón, Alejandro; Huete, Álvaro; Crovari, Fernando; Briceño, Eduardo

doi:10.1016/j.hpb.2021.11.009

Cited by 2 publications

(3 citation statements)

References 34 publications

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“…Consistent with our results, the polyp size has been recognized as the predictor of malignancy in the most recent guidelines 3,4 . On the other hand, the optimal cut‐off value calculated in this study is consistent with findings of other studies 7–11 …”

Section: Discussionsupporting

confidence: 93%

“…3,4 On the other hand, the optimal cut-off value calculated in this study is consistent with findings of other studies. [7][8][9][10][11] The available guidelines consider the followings as risk factors of malignancy in patients with gallbladder polyps: age more than 60 years, history of primary sclerosing cholangitis, Asian ethnicity, and sessile polypoid lesion. 3,4 The findings of current study does not support the age as the risk factor in patients with gallbladder polyp.…”

Section: Discussionmentioning

confidence: 99%

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The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication

Hajibandeh,

Ashar,

Parry

et al. 2023

J of Gastro and Hepatol

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Background and AimWe aimed to determine the risk and predictors of gallbladder cancer in all individuals with gallbladder polyps (GP) including those who did not have cholecystectomy.MethodsThe STROCSS guideline was followed to conduct a retrospective cohort study. All individuals with GP between 2010 and 2019 were followed up to determine the risk and predictors of gallbladder cancer. The primary outcomes were gallbladder cancer and gallbladder dysplasia, and the secondary outcomes included polyp growth rate and polyp disappearance rate. Binary logistic regression analysis and receiver operating characteristic curve analysis were conducted to evaluate the outcomes.ResultsAnalysis of 438 patients showed risk of gallbladder cancer was 0.7% in all polyps (0% in polyps < 10 mm; 5.9% in polyps ≥ 10 mm). The risk of gallbladder dysplasia or cancer was 1.1% in all polyps (0% in polyps < 10 mm; 10% in polyps ≥ 10 mm). The polyp size (P = 0.0001) was predictor of cancer; however, patient's age (P = 0.1085), number of polyps (P = 0.9983), symptomatic polyps (P = 0.3267), and change in size (P = 0.9012) were not. Size of 21 mm was cut‐off for risk of cancer (area under the curve [AUC]: 0.995, P < 0.001) and 11.8 mm for risk of dysplasia or cancer (AUC: 0.986, P < 0.001). The mean polyp growth rate was 0.3 mm/year and polyp disappearance rate was 16%.ConclusionsThe GP size remains the only predictor of malignant changes regardless of patient's age, patient's symptoms and number of polyps. The polyp growth rate is unremarkable, and a significant proportion disappears during follow‐up. We changed our follow‐up protocol with reduced number of scans and early discharge policy.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication

Hajibandeh,

Ashar,

Parry

et al. 2023

J of Gastro and Hepatol

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“…[83][84][85][86] Suspected findings include a single polyp, cross-sectional area ≥ 85 mm 2 , broad base, and medium echogenicity. [87] Size is the main risk factor, while multiplicity is related to benign disease. [88] Another proposed scoring system can accurately predict true polyps.…”

Section: Diagnosismentioning

confidence: 99%

Contemporary diagnosis and management of gallbladder polyps

Pavlidis,

Galanis,

Pavlidis

2023

Gastroenterol Funct Med

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Gallbladder (GB) polyps are present in 5%–10% of the general population and consist of true neoplastic polyps (adenomas) and pseudopolyps (predominantly cholesterol, inflammatory, hyperplastic, focal adenomyomatosis). True polyps, although relatively rare neoplastic lesions (0.5%) are considered an important factor in malignant transformation and cancer development (5%) when their size is ≥ 1 cm. Given that it is essential to diagnose GB adenocarcinoma at an early stage to optimize therapeutic management, controversy exists about whether cholecystectomy is always necessary. Their imaging characteristics, size ≥ 1 cm, age > 50 years and genetic predisposition determine the indications for immediate cholecystectomy. In younger patients with polyps < 1 cm in size and without a familial history of GB carcinoma, imaging follow-up by ultrasound (US) seems to be a reasonable recommended policy. A scoring system by multivariate analysis (cross-sectional area > 123 mm2, positive blood flow signal, age > 55.5 years, alanine aminotransferase (ALT) levels > 50 U/L and an ALT/AST (aspartate aminotransferase) ratio > 0.77) can accurately predict true polyps. The widely accepted size threshold for US follow-up is 7 mm, and for intervention, it is 10 mm. Computed tomography or better magnetic resonance imaging can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations. In challenging cases, high-resolution US, novel three-dimensional US, endoscopic US or contrast-enhanced endoscopic US could be helpful. Novel microflow imaging can safely predict polyps. Risk factors for malignancy include age > 60 years, large gallstones, primary sclerosing cholangitis, Asian ethnicity and sessile polyps accompanied by focal gallbladder wall thickening > 4 mm. For polyps sized 6–9 mm, the absence of growth at recommended follow-up (6 months, one year, and two years) indicates treatment discontinuation; however, it is not required for size < 5 mm without risk factors. In addition to laparoscopic cholecystectomy, the standard management, novel interventional modalities preserving the GB in selected cases include per-oral transmural endoscopic resection of GB polyps after a bridge of endoscopic US-guided cholecystostomy or laparoscopic gallbladder-preserving polypectomy. Generally, there are still no precise and strong evidence-based guidelines; thus, the management policy of GB polyps should be individualized in ambiguous cases.

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Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis

Cited by 2 publications

References 34 publications

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication

Contemporary diagnosis and management of gallbladder polyps

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