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| {{Infobox_Disease |
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| | '''For patient information on this topic click [[Gallbladder polyp (patient information)|here]].''' |
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| | {{Gallbladder polyp}} |
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| | ==[[Gallbladder polyp overview|Overview]]== |
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| | ==[[Gallbladder polyp historical perspective|Historical Perspective]]== |
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| '''Gallbladder polyps''' are a common clinical findings occurring in 5% of patients who often have cross-sectional imaging for non-specific abdominal symptoms.
| | ==[[Gallbladder polyp classification|Classification]]== |
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| When encountering patients with gallbladder polyps, it is important to note what type of polyp is described. While “true” polyps are adenomatous, gallbladder polyps are often non-epithelial growths and, in fact, about 70% of polyps are cholesterol polyps that have no malignant potential.
| | ==[[Gallbladder polyp pathophysiology|Pathophysiology]]== |
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| Adenomas are uncommon and constitute approximately 8% of all gallbladder polyps. Less common polypoid lesions include gallbladder adenocarcinomas, inflammatory polyps, gallstones masquerading as polyps and heterotopic tissue.
| | ==[[Gallbladder polyp causes|Causes]]== |
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| ==Epidemiology== | | ==[[Gallbladder polyp differential diagnosis|Differentiating Gallbladder Polyp from other Diseases]]== |
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| Polypoid lesions of the gallbladder affect approximately 5% of the adult population <ref name=" pmid 11930198 ">{{cite journal |author= Myers RP, Shaffer EA, Beck PL |title= Gallbladder polyps: epidemiology, natural history and management. |journal= Can J Gastroenterol. |volume=16 |issue=3 |pages=187-94 |year=2002 |pmid=11930198 }}</ref>. The causes are uncertain, but there is a definite correlation with increasing age and the presence of [[gallstones]] ([[cholelithiasis]]). Most affected individuals do not have symptoms. The gallbladder polyps are detected during abdominal ultrasonography performed for other reasons.
| | ==[[Gallbladder polyp epidemiology and demographics|Epidemiology and Demographics]]== |
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| The incidence of gallbladder polyps is higher among men than women. The overall prevalence among men of Chinese ancestry is 9.5%, higher than other ethnic types <ref name=" pmid 17725602 ">{{cite journal |author= Lin WR, Lin DY, Tai DI, Hsieh SY, Lin CY, Sheen IS, Chiu CT |title= Prevalence of and risk factors for gallbladder polyps detected by ultrasonography among healthy Chinese: analysis of 34,669 cases. |journal= Journal of Gastroenterol Hepatology |volume=23 |issue=6 |pages=965-9 |year=2008 |pmid=17725602 }}</ref>.
| | ==[[Gallbladder polyp risk factors|Risk Factors]]== |
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| ==Risk Stratification== | | ==[[Gallbladder polyp screening|Screening]]== |
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| After considering the type of polyps, the risk of development of cancer should be determined.
| | ==[[Gallbladder polyp natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Most demographic data suggest that men and women have an equal propensity to develop adenomatous polyps, however, one study found that men had an increased risk of polyp development.
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| In addition, several studies have noted that patients with [[primary sclerosing cholangitis]] (PSC) that have polyps are more likely to develop adenocarcinoma.
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| Finally, patients with advancing age may be predisposed to have cancer because some data suggests that gallbladder polyps, like colonic polyps, have an adenoma-to-carcinoma sequence and, therefore, advancing age would permit malignant transformation.
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| ==Pathomorphology==
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| Morphology and size have long been deemed important features of gallbladder polyps.
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| A “ten millimeter rule” for gallbladder polyps is often cited as a reason for [[cholecystectomy]] because polyps larger than 10 mm have an increased risk of cancer. Several caveats should be kept in mind when considering the size and morphology of gallbladder polyps.
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| *Polyps less than 5 mm rarely, if ever, harbor carcinoma.
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| *Polyps greater than 15 mm may have cancer cells in up to 70% of specimens.
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| *Polyps that are 5-15 mm must be carefully followed; with a risk of malignancy up to 22% in these patients. Finally, sessile polyps are more likely malignant than pedunculated polyps.
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| ==Symptoms== | |
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| Most polyps do not cause noticeable symptoms. Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain.
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| ==Diagnosis== | | ==Diagnosis== |
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| *Gallbladder polyps are typically identified on [[ultrasonography]], which has a sensitivity and specificity of over 90%.
| | [[Gallbladder polyp history and symptoms|History and Symptoms]] | [[Gallbladder polyp physical examination|Physical Examination]] | [[Gallbladder polyp laboratory findings|Laboratory Findings]] | [[Gallbladder polyp electrocardiogram|Electrocardiogram]] | [[Gallbladder polyp x ray|X Ray]] | [[Gallbladder polyp CT|CT]] | [[Gallbladder polyp MRI|MRI]] | [[Gallbladder polyp ultrasound|Ultrasound]] | [[Gallbladder polyp other imaging findings|Other Imaging Findings]] | [[Gallbladder polyp other diagnostic studies|Other Diagnostic Studies]] |
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| [http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] | |
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| <gallery>
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| Image:Gallbladder adenomatous polyp 1.jpg|USG: Gallbladder: Adenomatous polyp
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| Image:Polyp in gallbladder 1.jpg|51-year-old male with right lower quadrant pain. Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 2.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm).
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| </gallery>
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| <gallery>
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| Image:Polyp in gallbladder 3.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 4.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 5.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| </gallery>
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| <gallery>
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| Image:Polyp in gallbladder 6.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 7.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 8.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| </gallery>
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| <gallery>
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| Image:Polyp in gallbladder 9.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| Image:Polyp in gallbladder 10.jpg|Two small polyps are seen within the gallbladder (the largest of which measures 7mm)
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| </gallery>
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| * [[ERCP]] ([[Endoscopic Retrograde Cholangiopancreatography]])
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| *[[Contrast enhanced CT]] may aid in the diagnosis with an overall accuracy of 87% for cancer.
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| * HIDA Scan (Cholescintigraphy): Hepatobiliary iminodiacetic acid scan
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| *[[FDG-PET]] adds little to the CT.
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| *Importantly, [[endoscopic ultrasound]], which permits detailed evaluation of the gallbladder wall, has excellent diagnostic capabilities and should be used for indeterminate polyps of 5-15 mm.
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| ==Treatment== | | ==Treatment== |
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| Clinical decision-making for gallbladder polyps is rather straightforward since the options include surveillance versus [[cholecystectomy]].
| | [[Gallbladder polyp medical therapy|Medical Therapy]] | [[Gallbladder polyp surgery|Surgery]] | [[Gallbladder polyp primary prevention|Primary Prevention]] | [[Gallbladder polyp secondary prevention|Secondary Prevention]] | [[Gallbladder polyp cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gallbladder polyp future or investigational therapies|Future or Investigational Therapies]] |
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| [[Cholecystectomy]] should be considered in patients with polyps greater than 15 mm and smaller polyps that are sessile or found in patients with PSC. If the polyp is less than 15 mm and surveillance is the management of choice then re-evaluation should occur every 3-6 months because some studies suggest that polyps can increase in size 4-fold in 12 months. | |
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| If the rate of growth is nil, then surveillance can be stopped after 2 years.
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| If [[cholecystectomy]] is the treatment plan then one should consider the benefits of open versus [[laparoscopic cholecystectomy]]. Sentiment exists that laparoscopic cholecystectomy should not be performed if there is evidence of cancer because laparoscopic [[gallbladder cancer]] surgery is often complicated by port-site recurrence.
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| In one study, 16 patients with gallbladder polyps followed for 4 years had no recurrence. If the specimen demonstrates cancer that invades the muscular wall then [[radical cholecystectomy]] should be performed.
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| ==Prognosis and Complications==
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| When selecting [[cholecystectomy]] over surveillance, it is important to know the complications of [[cholecystectomy]].
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| In a large study of nearly 23,000 cholecystectomies, the local complication rate was 7%.
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| Systemic complications were observed in 2.3% of patients. [[Bile duct]] injury occurred in 0.3% of patients. Factors important in the outcome include [[body mass index]], male gender and surgeon experience.
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| ==References==
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| {{Reflist}}
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| ==External Links==
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| * [http://www.nlm.nih.gov/medlineplus/tutorials/cholecystectomyopenandlaparoscopic/gs019103.pdf Tutorial for patients]
| | ==Case Studies== |
| | [[Gallbladder polyp case study one|Case #1]] |
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| | [[Category:Disease]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Surgery]] | | [[Category:Surgery]] |
| | [[Category:Hepatology]] |
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