P-BN22 The use of virtual clinics in gallbladder polyp surveillance

Abstract

Background Gallbladder polyps are common findings on ultrasound with a prevalence between 0.3-9.5%. Their significance is not clear but are theorised to have potential risk of transformation into gallbladder malignancy which have poor prognosis if not caught early. Current guidelines recommend surveillance of polyps and that laparoscopic cholecystectomy should be offered if certain criteria are met. Most patients are asymptomatic and regular reviews in clinic is time consuming for patients and adds to strain on services. This study looks at the use of virtual clinics in gallbladder polyp surveillance. Methods Since January 2019 patients identified with gallbladder polyps have been added to virtual clinic. Each patient is added to a database which is maintained by one upper GI surgeon. Current guidelines are followed: laparoscopic cholecystectomy is offered if polyps are greater than 1cm, there is an increase greater than 2mm between scans, and in high-risk groups or in symptomatic patients. All other patients are offered interval scans as per guidelines and a template letter is generated informing patients of their scan results and date of their follow up scan. Results Since January 2019, 70 patients have been identified to have gallbladder polyps. Of these 48 patients so far have benefitted from involvement from follow up in virtual clinic to date, this has resulted in 88 clinic appointments being saved. 12 patients have undergone laparoscopic cholecystectomy due to increase in size of their gallbladder polyps or secondary to symptoms. 7 patients have been lost to follow up, 2 discharged due to the gallbladder polyps disappearing and the other 49 remain under surveillance in the virtual clinic. Conclusions Long term polyp surveillance can be time consuming for both the patient and clinician. This model of a virtual clinic maintains clear communication with patients about their scan findings, the risks associated and plans for future scans. This is an efficient method of monitoring these patients that has good compliance and identifies patients appropriate for surgery.