Gallbladder polyp is a general term for a type of lesion in which the wall of the gallbladder bulges into the lumen in a polyp-like manner, also known as “gallbladder augmentation lesion”. Clinically, gallbladder polyps include mucosal polyp-like hyperplasia caused by inflammation of gallbladder, polyp-like changes caused by degeneration of gallbladder mucosal cells, adenomatous polyps of gallbladder and polyp-like gallbladder cancer.
Pathology
There are benign polyps and malignant polyps. Benign polyps are divided into two categories: benign neoplastic polyps and pseudotumor polyps. Adenomatous polyps of the gallbladder are potentially precancerous lesions and are associated with the development of gallbladder cancer. In contrast, pseudotumoral polyps such as cholesterol polyps, inflammatory polyps and adenomyomatous gallbladder tumors are not cancerous.
Clinical manifestations
Most patients present with intermittent right upper abdominal discomfort with or without right shoulder and back discharge pain, and in some cases with biliary colic, accompanied by clinical symptoms such as abdominal pain, paroxysmal vomiting, abdominal distention and intolerance of fatty foods. In some cases, there are no clinical symptoms and the lesion is detected only during ultrasound examination.
Investigation
B ultrasound, CT, MRCP, cholecystography, etc.
Diagnosis
Diagnosis mainly depends on imaging examinations, including ultrasound, CT, MRCP, cholecystography, etc.
Treatment
It mainly involves the determination of benign and malignant gallbladder polyps, so as to achieve early detection of malignant lesions and precancerous lesions and early surgical removal.
1.Risk factors and surgical indications for malignant gallbladder polyps
(1) the size of gallbladder polyps Most scholars have considered that the size of gallbladder polyps is related to their benignity and malignancy. Small gallbladder polyps (<10mm in diameter) have been found to be mostly benign lesions and can remain unchanged for many years. For large gallbladder polyps, malignant lesions are indicated.
(2) Age The average age and diameter of gallbladder polyps in patients with gallbladder adenoma and gallbladder cancer are significantly older than in patients with non-neoplastic polyps.
(3) Number and morphology of polyps Single, broad-based polyps are prone to carcinogenesis. The malignant tendency of gallbladder polyps occurs in older, solitary, and large gallbladder polyps.
(4) Combination of gallbladder stones The relationship between gallbladder cancer and gallbladder stones is clear, and some patients with gallbladder cancer can be combined with gallbladder stones. Therefore, the presence of stones increases the risk of gallbladder carcinogenesis.
(5) Concomitant clinical symptoms Malignant gallbladder polyps are more likely to have concomitant clinical symptoms.
Combining the above risk factors for malignant gallbladder polyps, for young patients with gallbladder polyps, surgery is not necessary if the polyps are small in diameter (defined as 10 mm) and completely asymptomatic; for young patients with gallbladder polyps, conservative treatment is possible if the polyps are small in diameter and only have dyspeptic symptoms (abdominal distension, belching, etc.). For patients with significant biliary colic, especially with gallstones, cholecystectomy should be performed; for patients with polyps >10mm in diameter and risk factors for gallbladder polyp malignancy, early cholecystectomy should be performed. For patients with polyps <10mm in diameter and without risk factors of gallbladder polyp malignancy, they can be observed and ultrasound investigation can be performed regularly.
2.Surgical treatment
For patients with polyps less than 10mm in diameter, multiple polyps with a tip, suggesting the possibility of pseudotumor polyps, laparoscopic cholecystectomy is preferred. For patients with polyps >10 mm in diameter and risk factors for malignant gallbladder polyps, they are suggested to be neoplastic polyps and should undergo routine open cholecystectomy. Intraoperative frozen sections are routinely performed to clarify the pathological category. In case of cancerous polyps, simple cholecystectomy is feasible if the tumor is confined to the mucosa; once the tumor invades the muscular layer, an extended resection including wedge resection of the liver in the gallbladder bed and lymph node dissection is required.
Although there are many controversies in the surgical management of gallbladder polyp-like lesions, in general, gallbladder polyps >10 mm in diameter, age >50 years, solitary, broad-based and combined with gallbladder stones have been considered as risk factors for gallbladder polyp malignancy. Selection of patients suitable for surgery can be based on these risk factors. For gallbladder polyps <10 mm in diameter and without clinical symptoms, ultrasound exploration can be performed periodically, and if abnormalities are detected, prophylactic surgical resection is performed.