Gallbladder polyps are exophytic or bulging lesions that occur on the mucosal wall of the gallbladder. They are usually found during a physical ultrasound examination or during cholecystectomy. Most gallbladder polyp-like lesions are hyperplastic polyps or cholesterol deposits rather than neoplastic polyps. The rate of finding gallbladder polyps during routine physical examinations is approximately 1.5 – 4.5%. Unlike gallbladder stones, the development of gallbladder polyps is not correlated with age, sex, weight, pregnancy, estrogen, etc. 1, the classification of gallbladder polyps Generally speaking gallbladder polyps can be divided into benign and malignant lesions, benign gallbladder polyp-like lesions can be divided into tumor and non-tumor polyps. The most common benign non-neoplastic polyp-like lesion and the most common gallbladder polyp found during physical examination is cholesterol polyp (cholesterol deposition), followed by adenomyomatosis. These 2 types of polyps are also referred to as hyperplastic polyps to distinguish them from inflammatory polyps. Some data suggest that adenomyomatosis of the gallbladder may increase the risk of gallbladder cancer, but this is more controversial. The most common benign neoplastic polyp-like lesions are adenomatous polyps, while mesodermal tumors such as smooth muscle tumors and lipomas are less common. The most common malignant lesion is adenocarcinoma of the gallbladder. Unlike adenomatous polyps of the colon, which are more common than colon cancer, adenomatous polyps of the gallbladder are less common than gallbladder cancer. Adenocarcinoma of gallbladder, squamous cell carcinoma and adenosquamous carcinoma are less common in clinical practice. 2.How to determine the nature of gallbladder polyps Gallbladder polyp-like lesions are mainly examined by ultrasound to clarify the nature of the lesion, and those that cannot be characterized by conventional ultrasound should be identified by ultrasound contrast (contrast enhanced ultrasound, CEUS) or enhanced CT, especially for those that are suspected to be cancerous, these blood flow Dynamic examination. Cholesterol polyps are usually multiple, homogeneous, and tipped polyps that are often more echogenic than the liver parenchyma and may contain hyperechoic dots and mulberry-like surfaces, while adenomatous polyps are often homogeneous, isoechoic polyps that are smooth, tipped, or broad-based. Gallbladder carcinoma, on the other hand, usually presents as an inhomogeneous isoechoic or hypoechoic polyp-like lesion with an unsmooth surface and poorly defined borders, usually without a tip. When located at the base of the gallbladder, adenomyosis may appear as a polypoid lesion with a nonspecific focal or diffuse thickening of the gallbladder on ultrasound, which may be accompanied by a circular anechoic focus (intra-mucosal diverticulum). There is a correlation between the size of the polyp and the risk of carcinoma, with gallbladder polyps larger than 2 cm almost always being malignant and often in a progressive stage. Polyps between 1 – 2 cm are malignant in about 43 – 77% of patients. Patients aged 50–60 years are also one of the high-risk factors for malignant gallbladder polyps. 3.Surgical indications Most of the gallbladder polyps are cholesterol polyps and inflammatory polyps, which mostly have no clinical symptoms and will not become cancerous, so they do not need medication and surgery. Reducing greasy food and physical exercise are beneficial to cholesterol polyps. Cholecystectomy is generally used to prevent cancer or treat malignant lesions of the gallbladder, and patients with suspected adenoma, adenomyosis or cancer of the gallbladder should be operated. Therefore, indications for surgery for gallbladder polyps are generally based on imaging, usually based on polyp size, number, base, texture, and blood flow. In principle, polypoid lesions larger than 1 cm, solitary, with a wide base, poorly uniform texture, poorly defined borders, and a blood flow signal, of which two criteria are met, are at significantly increased risk of gallbladder adenoma, adenomyosis, or carcinoma and require cholecystectomy. Additional gallbladder polyps with stones or symptoms also require surgical treatment.