Surgical tactics in patients with gallbladder polyps
DOI:
https://doi.org/10.11603/2414-4533.2019.4.10720Keywords:
gallbladder polyps, ultrasound, cholecystectomy, gallbladder cancerAbstract
The prevalence of gallbladder polyps comprises from 1 to 9.5 % of the general population; the probability of adenoma diagnosis increases significantly in case the polyp diameter is larger than 10 mm. The incidence of gallbladder polyps disease varies depending on the geographical region (higher in Asia) or ethnicity, but it is the same among men and women. There are pseudotumor polyps and tumor polyps. The most accessible method for the gallbladder polyps diagnosis is ultrasound monitoring. At the preoperative stage, it is difficult to determine the probability of gallbladder carcinoma that originated from the polyp, so some risk factors are singled out: polyp diameter is over 10 mm, patient’s age is over 50 years, broad base polyp, local thickening of the gallbladder wall is over 4 mm, sclerosing cholangitis, Indian ethnicity, single polyp, cholelithiasis and polyps in other areas of the gastrointestinal tract. In case of the asymptomatic gallbladder polyps sized over 10 mm, a planned cholecystectomy is clearly recommended. If the patient has a risk of malignancy, this size should be reduced to 6 mm. Cholecystectomy is recommended for gallbladder polyps, regardless of their size, if there are specific clinical symptoms connected with the biliary system, or polyps associated with primary sclerosing cholangitis.
When analyzing clinical symptoms and primary ultrasound examination, it is extremely difficult to differentiate between pseudotumor and tumor polyps. Tumor polyps have a high risk of malignancy, which requires long time ultrasound monitoring. The indications for surgery on gallbladder polyps are clearly-regulated, however active surgical tactics should be followed in case of suspected gallbladder carcinoma.
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