Are we performing too many unnecessary cholecystectomies for gallbladder polyps?

MEMBER ARTICLE

Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk.

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• Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk.

• 
  Cholecystectomy for gallbladder polyps is only indicated for adenomas, which can be premalignant.

  • ◦ 

    European guidelines between the ESGAR, EAES, EFISDS and ESGE that provide recommendations for indication for cholecystectomy and duration of follow-up for gallbladder polyps were updated in 2022.

Study: 

Cohort of 302 patients followed up for two years

- 88 underwent cholecystectomy 

- In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines.

- The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age.

- Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). 

- An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

• What are the significant and/or new findings of this study?

  • ◦ 

    An adenoma was found in only six of 68 (9%) patients who underwent cholecystectomy that was advised according to 2022 European guidelines.

  • ◦ 

    The revised guidelines provided only a minor decline in cholecystectomy for non-neoplastic polyps (three patients).

  • Source https://onlinelibrary.wiley.com/doi/10.1002/ueg2.70057

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