The prevalence of gallbladder polyps is 4-10% in the normal population and 2-12% in gallbladder resection specimens. Gallbladder polyps themselves represent a group of abnormal lesions of the gallbladder wall and can be classified as non-neoplastic or aneurysmal. Non-neoplastic includes hyperplastic and inflammatory polyps, while neoplastic polyps include benign (e.g. adenomas, adenomyomas, smooth muscle tumors, fibromas, and lipomas) and malignant (e.g. adenocarcinomas, squamous cell carcinomas, and mucinous cystadenocarcinomas). The reason why gallbladder polyps need to be taken seriously is that some can become cancerous. Among abdominal tumors, gallbladder cancer is the king of cancers, and early detection and early treatment are the keys to improve the survival rate of gallbladder cancer patients. With the popularization of ultrasound physical examination, there are many early gallbladder cancers that are discovered by chance when gallbladder polyps are surgically removed, which means early gallbladder cancer is sometimes easily confused with gallbladder polyps. Do I need to cut my gallbladder if I have gallbladder polyps? Whether to cut it or not depends on the risk of cancer. Let’s take a specific example to understand: Ms. Zhang was found to have a polyp (5mm x 3mm) in her gallbladder 3 months ago during her physical examination. Recently, she reviewed the ultrasound and found that the polyp had grown to 9 mm x 5.4 mm. As the polyp grew faster, the doctor recommended surgery to remove the gallbladder. Miss Zhang is in good health and does not suffer from discomfort due to polyps, but she is afraid of the effects of removing the gallbladder on her body and is reluctant to undergo surgical treatment. It is generally believed that gallbladder polyp is a predisposing factor for gallbladder cancer. In recent years, there are also many reports about gallbladder polyp cancer at home and abroad, especially when accompanied with stones, the probability of cancer will be significantly increased. Therefore, if there are any of the following conditions – gallbladder polyp with diameter over 1 cm, patient’s age over 50 years, single lesion, polyp gradually increasing in size, combined with gallbladder stones, etc., it is considered as a risk factor for malignant lesion and the gallbladder should be removed and biliary preservation surgery is not advocated. Patients who do not have the above conditions and are asymptomatic should not be rushed to surgery and should be reviewed by ultrasound once every 6 months. As in the case of Miss Zhang above, the polyp grew nearly 4 mm in 3 months, and it is a single lesion, so surgery is recommended to remove the gallbladder. How to correctly understand the ultrasound report Often patients come to the clinic with the ultrasound report, in fact, the ultrasound report describes “polypoid lesion of gallbladder”. The term “polypoid” means that it looks like a polyp, but not necessarily a polyp. For example, cholesterol crystals or sediment-like stones commonly found in the clinical setting can form small protrusions on the mucosal surface of the gallbladder when they stick to the mucosal folds under thick bile, much like polyps, but not in the true sense of the word. They tend to be multiple and usually do not need to be treated. However, if they are true polyps, they should be taken seriously enough. In fact, it is difficult to clarify the pathological nature of gallbladder polyps by ultrasound, and for polyps under 1 cm, sometimes CT and MRI cannot distinguish between benign and malignant. Currently, the common clinical indication is polyps larger than 1 cm in length, based on previous clinical observations that polyps larger than 1 cm have a significantly higher chance of becoming cancerous. However, studies have also shown that 40% of malignant gallbladder polyps can be smaller than 1 cm. The guidelines of the Society of American Gastroenterologists and Endoscopists (SAGES) even advocate surgical treatment of polyps larger than 5 mm. As you can see, there is no uniform standard for how large a polyp needs to be operated on. Therefore, the clinical management of polyps requires a combination of factors. However, if a patient with gallbladder polyps has risk factors (e.g., associated stones, rapid enlargement, solitary, symptomatic, congenital bile duct abnormalities, and female, over 60 years of age), early surgical removal of the gallbladder should be appropriately considered. Of course, there is no need to be nervous about having gallbladder polyps, as the doctor will give the most suitable treatment plan according to the situation.