Introduction
A gallbladder polyp is described as a raised (elevated), sessile (fixed), or pedunculate (attached to the base) gallbladder mucosa protruding into the lumen. These benign lesions are frequently discovered accidentally during imaging or following a cholecystectomy (surgical procedure to remove gallbladder) in individuals with acute cholecystitis (inflammation of the gallbladder) or biliary colic. The main concern is that these benign lesions could progress to cancer.
What Are the Two Types of Gallbladder Polyps?
The two types of GB polyps are:
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Pseudo polyps - Which are benign in nature.
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True polyps - Have the potential to become cancerous.
Just five percent of reported polyps are true. For those malignant polyps to receive effective therapy and guarantee long-term survival, it is critical to correctly diagnose them. In terms of clinical presentation, polyps can either be asymptomatic or show signs of acute cholecystitis when they obstruct the cystic ducts or cholangitis when their pieces impede the bile ducts.
Surgery is not always necessary for GB polyps because pseudopolyps are not cancerous. The procedure has a number of side effects, including bile duct damage, bile leaks, and damage to intra-abdominal structures. When it comes to "true" GB polyps, cholecystectomy is the recommended procedure, and laparoscopic cholecystectomy is the preferred approach. Pseudopolyps do not need any more monitoring, interventional therapy, or follow-up.
What Is the Incidence of Gallbladder Polyps?
GB polyps are typically found on abdominal ultrasounds and have an incidence of 0.3 to 9.5 percent. With a male-to-female ratio of 1.15:1, they are primarily seen in men and are often identified at the age of 49. Pseudopolyps make up around 70 percent of the polyps.
What Are the Various Types of Gallbladder Polyps?
In the year 1970, Christensen and Ishak classified benign polyps as:
1. Pseudopolyps - Cholesterol polyps, inflammatory polyps, cholesterolosis, and hyperplastic polyps.
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Cholesterol Polyps: With an estimated prevalence between 60 and 90 percent, cholesterol polyps are the most prevalent type of GB polyps. They are tiny, numerous polyps that are less than 10 mm in diameter and do not have the potential to turn cancerous. Cholesterol polyps are a consequence of metabolic syndrome.
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Inflammatory Polyps: These benign polyps have a 10 percent prevalence and a diameter of less than 10 mm. These polyps frequently accompany chronic cholecystitis because their pathophysiology is connected to localized epithelial proliferation brought on by chronic inflammation.
2. Epithelial Tumors - Adenomas.
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GB Adenomas: These unusual, benign tumors are regarded to have a premalignant potential. The diameter of these typically single lesions ranges from 5 mm to 20 mm. Often asymptomatic, they are identified accidentally on imaging or with cholecystectomy specimens. A few people may develop symptoms due to cystic duct obstruction or because they have gallstones that are symptomatic.
It might appear macroscopically as sessile, pedunculated, or polypoid. It may appear microscopic in a tubular, papillary, or tubulopapillary shape, with the tubular variety appearing on histology reports the most frequently.
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Adenomyomatosis: They make up 25 percent of GB polyps and are considered to be precancerous lesions. They are typically discovered as a single polyp in the GB fundus, and their frequency rises with age.
3. Mesenchymal Tumors - Fibromas, lipomas, and hemangiomas. Cholesterol polyps are the most prevalent type of benign GB polyps, which are often asymptomatic; by contrast, malignant adenocarcinoma prevalence is only 0.4%.
What Is the Clinical Presentation?
- GB polyps are commonly symptomatic and discovered by chance during an ultrasound. They occasionally have undefined gastrointestinal symptoms including nausea, vomiting, and right hypochondrial discomfort as a result of intermittent obstruction brought on by cholesterol flakes that have broken off from the GB mucosa.
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Acute cholecystitis or obstructive jaundice can very rarely result from certain big polyps blocking the cystic duct. Clinically, benign and malignant polyps present similarly.
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A study showed that 23 percent of the polyps presented with gastrointestinal symptoms, 13 percent had elevated liver function tests, and 64 percent of the polyps were discovered accidentally during a workup for an unrelated condition.
What Are the Risk Factors Associated With GB Polyps?
There has not been a significant investigation to determine the risk factors for GB polyp development. Fat metabolism is associated with the pathogenesis of gallbladder polyps. But no correlation between polyp development and age, gender, obesity, or diabetes mellitus has been identified. Polyps smaller than 10 mm are commonly considered benign. Studies, however, have revealed malignant polyps smaller than 10 mm. In order to facilitate early detection and the most appropriate malignancy treatment, it is crucial to determine the risk factors linked to polyp malignancy.
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Number of Polyps: There is some evidence that isolated polyps are more dangerous than many polyps, however, this is debatable. Solitary polyps should be examined for malignancy in conjunction with other risk factors for cancer.
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Shape: Multiple polyps are less malignant than a single solitary polyp. Cholecystectomy is advised because a single sessile polyp has a 24.8 percent chance of being malignant.
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Size (Diameter of the Polyp): Sizes greater than 3.94 inches are believed to indicate a significant risk of cancer.
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Age: In the fifth and sixth decades of life, gall bladder carcinoma incidence increases. According to Bhatt et al. Persons over 50 with polyps smaller than 10 mm in diameter have a 20.7 percent chance of developing carcinoma.
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Ethnicity: Asian and Indian ethnic groups have a 13 times greater chance of developing cancer than Caucasians.
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Gallstones: It is not well established that gallstones and stomach cancer are related.
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Primary Sclerosing Cholangitis (PSC): A case series of four patients with primary sclerosing cholangitis and gallbladder polyps showed that all of them, irrespective of the size of the polyp, was diagnosed as malignant.
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Tumor Markers: The tumor indicators and the risk of malignancy do not positively correlate linearly.
What Are the Imaging Techniques for Monitoring GB Polyps?
The diagnosis of GB polyps relies heavily on radiological imaging, which also aids in choosing the type of treatment to use and the frequency of follow-up visits. Imaging methods distinguish polyps from additional GB diseases. Also, it aids in the distinction between genuine polyps and pseudopolyps, which require various approaches to therapy according to their risk for malignancy. Monitoring polyps involves the use of ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI).
What Is the Management of Gallbladder Polyps?
The size of the lesion on radiological imaging has a significant impact on how polyps are managed. Malignant polyps are larger and bigger than 10 mm in size. The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) currently advises that polyps that are 10 mm or larger should undergo cholecystectomy. Patients with polyps six to nine mm in size are advised to have follow-up exams every six months. Patients with polyps of less than six mm should undergo routine screening at 1, 3, and 5 years, and a cholecystectomy should be done right away if the polyps are larger than 10 mm (greater than 1 cm). Cholecystectomy is necessary for lesions that show signs of growth, vascularity, invasion or are symptomatic.
Conclusion
The most frequent surgical vesicular pathology discovered accidentally on ultrasound or in the cholecystectomy material following a bout of acute or chronic cholecystitis is B polyps. Most of the patients have no symptoms. The most effective diagnostic technique for locating polyps is ultrasound. The majority of polyps are benign; occasionally, malignant polyps are discovered. Surveillance is advised for early discovery, rapid treatment, and a better prognosis due to the terrible prognosis of GB cancer.
