What Are Gallbladder Polyps?

Gallbladder polyps is a general term for a class of lesions with polypoid-like protrusions in the gallbladder wall into the cavity, including tumorous polyps and non-neoplastic polyps. Because it is difficult to determine their properties in clinical and imaging studies, Also called "gallbladder mucosal bulging disease". Gallbladder polyps have benign and malignant polyps in pathology, and benign polyps are more common. Benign gallbladder polyps include cholesterol polyps, inflammatory polyps, adenomatous polyps, glandular myoplasia, and tissue ectopic polyps. Adenomatous polyps of the gallbladder are potential precancerous lesions that are related to the occurrence of gallbladder cancer. In contrast, non-tumor polyps such as cholesterol polyps, inflammatory polyps, and gallbladder adenomas do not become cancerous.

Basic Information

nickname: Gallbladder mucosal bulging lesions
English name: gallbladder polyps

Visiting department: Hepatobiliary surgery
Common symptoms: Abdomen tightness and discomfort, right upper quadrant pain or colic after fat meal

Causes of gallbladder polyps

The etiology of gallbladder polyps is more complex and may be related to chronic cholecystitis, gallbladder stones, and disorders of cholesterol metabolism. Obesity, smoking, hyperlipidemia, hyperinsulinemia, liver cirrhosis, and anatomic abnormalities of the upper digestive tract and biliary tract are the prone factors of gallbladder polyps.

Gallbladder polyps clinical manifestations

Most patients have no discomfort and are often found by accident during a B-ultrasound during a health checkup or population survey. Symptoms are the most common symptom of abdominal distension and discomfort, which is generally not heavy and can be tolerated. If the lesion is located in the neck of the gallbladder, it can affect the emptying of the gallbladder, and right upper quadrant pain or colic occurs after a regular meal, especially after a fat meal. Abdominal pain is more pronounced in patients with gallstones or chronic cholecystitis. Rare symptoms include obstructive jaundice, biliary tract bleeding, acute cholecystitis, and pancreatitis, which are related to polyps in the neck of the gallbladder blocking the gallbladder duct or polyps shedding in the ampulla.

Gallbladder polyps

Routine ultrasound examination

The detection rate of gallbladder polyps can reach more than 95% by ultrasound, which is the first diagnosis method for gallbladder polypoid lesions. Under ultrasound, it is a strong echo group connected to the gallbladder wall, which does not move with the change of body position, and there is no sound shadow behind.

2. Endoscopic ultrasound

The image is sharper and the resolution of polyps is higher. Helps determine the benign and malignant polyps.

3.CT enhanced scan

Contribute to the differential diagnosis of gallbladder cancer.

4. Ultrasound guided percutaneous fine needle aspiration biopsy

Cholesterol polyp is the deposition of cholesterol crystals on the mucosal surface of the gallbladder; inflammatory polyps are hyperplasia of the gallbladder mucosa, which are often combined with gallbladder stones and cholecystitis; gallbladder adenoma is a localized benign proliferative lesion of the gallbladder wall. Gallbladder adenoma polyps are papillary hyperplasia or nodular pyloric hyperplasia of the gallbladder epithelium, which can be accompanied by intestinal metaplasia and heterosexual hyperplasia.

Diagnosis and differential diagnosis of gallbladder polyps

Because the disease has no specific clinical manifestations, the diagnosis mainly depends on imaging studies. A small number of gallbladder polyps can become cancerous, and some early gallbladder cancers also appear in the form of polyps, which should be identified. Endoscopic ultrasonography, CT enhanced scanning, ultrasound-guided percutaneous fine needle aspiration biopsy, and tumor molecular marker examination can help confirm the diagnosis and distinguish benign from malignant.

Gallbladder Polyps Treatment

It mainly involves the determination of benign and malignant polyps of the gallbladder, so as to achieve early detection of malignant and precancerous lesions and early surgical resection.

1. Risk factors and surgical indications for gallbladder polyps

(1) Size of gallbladder polyps Most scholars have considered that the size of gallbladder polyps is related to their benign and malignant. Small gallbladder polyps (<10mm in diameter) have been found to be mostly benign and can remain unchanged for many years. Large gallbladder polyps suggest malignant lesions.

(2) Age The average age of gallbladder adenoma and gallbladder cancer and the diameter of gallbladder polyps were significantly larger in patients with gallbladder polyps than in patients with non-tumor polyps.

(3) Number and form of polyps Single, broad-based polyps are prone to cancer. Malignant lesions of gallbladder polyps tend to occur in older, solitary, large gallbladder polyps.

(4) Combined with gallbladder stones The relationship between gallbladder cancer and gallbladder stones has been relatively clear. Some patients with gallbladder cancer can be associated with gallbladder stones at the same time. The long-term stimulation of stones can promote the proliferation of gallbladder epithelial cells and cause cancer. Therefore, the presence of stones increases the risk of gallbladder cancer.

(5) Accompanying clinical symptoms Malignant gallbladder polyps are more prone to accompanying clinical symptoms.

Based on the above risk factors of gallbladder polyps, for young patients with gallbladder polyps, if the diameter of the polyps is small (with a boundary of 10mm) and there are no symptoms at all, surgery is not necessary; patients with obvious biliary colic, especially with gallstones Cholecystectomy; For patients with a polyp diameter> 10mm and risk factors for malignant change of gallbladder polyps, cholecystectomy should be performed as soon as possible. For patients with a diameter of less than 10mm and no risk factors for gallbladder polyps malignancy, they can be observed and regularly examined with ultrasound.

2. Choice of surgical method

For patients with multiple pedicled gallbladder polyps with a diameter of less than 10mm, it is suggested that the lesion is a pseudotumor polyp, and laparoscopic cholecystectomy is the first choice. For patients with a polyp diameter> 10mm and risk factors for malignant change of the gallbladder polyps, it is suggested that the tumor should be a conventional open cholecystectomy. Frozen sections were routinely performed during operation to determine the pathological category. For cancerous polyps, simple cholecystectomy is possible when the tumor is confined to the mucosa; once the tumor invades the muscular layer, an enlarged resection is required, including wedge resection of the gallbladder bed and lymph node dissection.

Although there are many controversies regarding the surgical treatment of gallbladder polypoid lesions, in general, the diameter of gallbladder polyps> 10mm, age> 50 years, single, broad-based and combined with gallstones have been considered as risk factors for gallbladder polyps . Patients suitable for surgery can be selected based on these risk factors. For gallbladder polyps with a diameter of less than 10 mm and no clinical symptoms, regular ultrasound exploration can be performed. If abnormalities are found, preventive surgical resection is performed.