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Gallbladder polyps

Key sources
The following summarized guidelines for the evaluation and management of gallbladder polyps are prepared by our editorial team based on guidelines from the European Society of Gastrointestinal Endoscopy (ESGE/EFISDS/EAES/ESGAR 2022), the American Association for the Study of Liver Diseases (AASLD 2022), the European Association for the Study of the Liver (EASL 2022; 2016), the British Society of Gastroenterology (BSG 2019), the American College of Gastroenterology (ACG 2015), and the American Society for Gastrointestinal Endoscopy (ASGE 2013).
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Guidelines

1.Classification and risk stratification

Risk of malignancy: consider obtaining multidisciplinary discussion to assess the perceived individual risk of malignancy in patients with polypoid lesions of the gallbladder measuring ≥ 10 mm.
B
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2.Diagnostic investigations

Diagnostic imaging
Obtain abdominal ultrasound for primary evaluation of polypoid lesions of the gallbladder.
B
Consider obtaining alternative imaging modalities (such as contrast-enhanced and EUS) to aid decision-making in difficult cases in centers with appropriate expertise and resources.
B

3.Surgical interventions

Indications for cholecystectomy, polyps >= 10 mm, ESGE/EFISDS/EAES/ESGAR: perform cholecystectomy in surgically fit patients with polypoid lesions of the gallbladder measuring ≥ 10 mm.
B

More topics in this section

  • Indications for cholecystectomy (polyps 6-9 mm)

  • Indications for cholecystectomy (polyps <= 5 mm)

  • Indications for cholecystectomy (symptomatic polyps)

  • Indications for cholecystectomy (growing polyps)

4.Specific circumstances

Patients with primary sclerosing cholangitis, monitoring, AASLD: consider obtaining ultrasound surveillance every 6 months in patients with PSC and gallbladder polyps ≤ 8 mm.
E

More topics in this section

  • Patients with PSC (cholecystectomy)

5.Follow-up and surveillance

Serial imaging assessment: as per ESGAR 2022 guidelines, do not obtain follow-up in patients with a gallbladder polypoid lesion of ≤ 5 mm and no risk factors for malignancy.
D
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