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Management and diagnosis of gallbladder polyps: a systematic review

  • Systematic Review and Meta-analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs.

Methods

MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points.

Results

Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32–83). Patients with malignant GBPs had an average (range) age of 58 (50–66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5 % of GBPs followed by adenomas (15.2 %) and cancer (11.6 %). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0 % of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy.

Conclusions

Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following:

1. Surveillance may not be needed for GBPs <5 mm.

2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years.

3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.

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Author contributions

G. Garcea and B.I. Babu contributed to the study conception and design and drafting of the manuscript. B. I. Babu was responsible for the acquisition, analysis and interpretation of the data. A.R. Dennison and G. Garcea for the critical revision of the manuscript.

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Authors and Affiliations

  1. Leicester HPB Unit, University Hospitals of Leicester, Gwendolen Road, LE5 4PW, Leicester, UK

    Benoy I. Babu, Ashley R. Dennison & Giuseppe Garcea

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  1. Benoy I. Babu
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  2. Ashley R. Dennison
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  3. Giuseppe Garcea
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Correspondence to Benoy I. Babu.

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Babu, B.I., Dennison, A.R. & Garcea, G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbecks Arch Surg 400, 455–462 (2015). https://doi.org/10.1007/s00423-015-1302-2

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  • DOI: https://doi.org/10.1007/s00423-015-1302-2

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