Gallbladder polyps, is there a high rate of malignancy?

The gallbladder is located in the right upper abdomen, like a pear-shaped bag hanging below the liver, its main function is to collect and store bile secreted by the liver, when the body needs to excrete to the intestine to help digest and absorb food. Gallbladder polyps are redundant organisms that grow on the inner wall of the gallbladder cavity, small ones are shaped like corn only 1mm~2mm, and the large ones look like mulberries up to 2cm. Because it is difficult to clarify its nature in clinical and imaging examinations, it is also known as “gallbladder mucosal elevated lesions”. Pathologically, there are benign polyps and malignant polyps, but benign polyps are more common. Benign gallbladder polyps include cholesterol polyps, inflammatory polyps, adenomatous polyps, adenomatous hyperplasia and tissue ectopic polyps. Of these, adenomatous polyps are potentially precancerous and have been linked to the development of gallbladder cancer. In contrast, non-neoplastic polyps such as cholesterol polyps, inflammatory polyps and adenomyomas of the gallbladder are not cancerous. The etiology of gallbladder polyps is complex and may be related to chronic cholecystitis, gallbladder stones and cholesterol metabolism disorders. Meanwhile, obesity, smoking, hyperlipidemia, hyperinsulinemia, liver cirrhosis, anatomical abnormalities of the upper gastrointestinal tract and biliary tract are also favorable factors for gallbladder polyps. About 5% of the population suffers from gallbladder polyps, and most of the patients do not have any discomfort manifestations, which are often found incidentally by abdominal ultrasound during health examination or population census. The most common symptom in symptomatic patients is upper abdominal discomfort, which is usually not serious and can be tolerated. If the lesion is located in the neck of the gallbladder, it may affect the emptying of the gallbladder, and right upper abdominal pain or colic often occurs after meals, especially after eating greasy food. In combination with gallbladder stones or chronic cholecystitis, abdominal pain is more pronounced. Rare symptoms include obstructive jaundice, biliary bleeding, acute cholecystitis, pancreatitis, and so on, which are very much related to the polyps in the neck of the gallbladder obstructing the gallbladder duct or the polyps dislodged and embedded in the jugular abdomen. For the vast majority of gallbladder polyps found incidentally during a physical examination and do not cause any symptoms, the need for treatment depends mainly on the size of the polyp and the rate of growth. The treatment of these polyps is as follows: polyps of up to 5 mm are detected at the first examination and are reviewed by ultrasound once a year thereafter. If the polyp is more than 5 millimeters but not up to 1 centimeter, the ultrasound will be performed again in six months, and if the size does not change, it can be repeated once a year; on the other hand, if the polyp increases, it should be followed up closely to shorten the interval between examinations. If the size of the polyp reaches 1 cm or larger, or if the polyp increases more than 3 mm in the follow-up examination, cholecystectomy should be performed to exclude the possibility of cancer, and histologic identification should be done. Overall, the vast majority of asymptomatic gallbladder polyps do not require treatment, and this is even more reassuring in the case of multiple small polyps, which are essentially diagnosed as cholesterol polyps. Larger polyps require removal of the gallbladder. Surgery is primarily prophylactic, and in most cases the lesion remains benign after removal. As long as the surgery is performed in a timely manner, the prognosis is good, even if the polyp has become malignant at an early stage. After the removal of the gallbladder, the bile secreted by the liver is directly discharged into the intestines to carry out the digestive function, and the surgery generally has no obvious adverse effects on the body.