Gallbladder polyps: most of them are asymptomatic, and 85% of them are found only through routine physical examinations. Modern people are already afraid of finding out something wrong, and once they are found to have gallbladder polyps, they are worried and terrified. That is because people are not aware of gallbladder polyps and are afraid for no reason. Why do gallbladder polyps make people feel so frightened? Let’s look at what doctors usually say: “Your polyp is one centimeter, cut out the gallbladder quickly, or it will not become cancerous!” Let’s look at some information from the Internet: “The average cancer rate of gallbladder polyps has increased from 1-2% to 8-12%, becoming a major killer in modern cities.” There is also information such as “Gallbladder polyps are potentially aggressive and have a high cancer rate”. For a person who has just been found to have gallbladder polyps, when he hears these, inquires about these, sees these, can he not be afraid? Is the above not true at all? Of course not, the knowledge about gallbladder polyps does include all these. But we can’t just ignore it.
1, gallbladder polyps is not a disease? A polyp is a superfluous organism, and in layman’s terms a polyp is something that should not be there. Gallbladder wall to the gallbladder cavity growth of superfluous should not exist, we call the gallbladder polyps also known as gallbladder bulge-like lesions, is a common benign gallbladder disease. The prevalence of gallbladder polyps is reported to be 3-6% in the literature, and the majority of gallbladder polyps are asymptomatic and 85% are detected by ultrasound during a routine physical examination. A gallbladder polyp is similar to a superfluous skin lesion, commonly known as a wart, except that it is not on the skin but on the mucosa of the gallbladder. Gallbladder polyp is asymptomatic and does not affect the function of the gallbladder, if it does not become cancerous, then it is strictly speaking, it is not considered a real disease.
2.What kind of gallbladder polyps should be operated? Does a gallbladder polyp have to wait until it becomes cancerous before surgery? To answer these two questions, we must first understand the clinical classification and treatment response of gallbladder polyps. Clinically, the so-called gallbladder polyps or gallbladder augmentation-like lesions are actually a group of gallbladder diseases that contain many different pathological states. The current common pathological classification is divided into two categories: non-neoplastic and neoplastic lesions. The clinical classification of gallbladder polyps is as follows.
Type I: cholesterol polyps. It is also called pseudopolyps. To date, no cancerous lesions have been reported. It has a mulberry-like appearance, brittle and fragile, with a thin tip like cotton thread, which can be easily dislodged, mostly within 10 mm, mainly multiple, and located in the body of the gallbladder. Most patients with cholesterol polyps have no symptoms or mild symptoms, and the gallbladder functions well, so they can be reviewed by ultrasound every 3-6 months to observe the change in size. Surgery should be considered only if there are significant symptoms or if the size increases significantly within a short period of time. For those with good gallbladder function and no acute or chronic inflammation of the gallbladder, choledochoscopy and laparoscopy combined with endoscopic examination, biopsy and treatment of the gallbladder can be preferred.
Category 2: Benign non-cholesterol polyps. Also known as true polyps. They mainly refer to: adenoma, adenomyoma, inflammatory polyp, adenomatous hyperplasia of the gallbladder, of which adenoma is a recognized precancerous lesion with a cancer rate of about 10%, and adenomyosis also has a potential cancer risk. Therefore, these lesions should be subjected to prophylactic cholecystectomy, with laparoscopic cholecystectomy being the first choice.
The third category: polyp-type early gallbladder cancer. At present, for polyp-based early gallbladder cancer mixed with gallbladder polyps, we mainly rely on ultrasound to detect them. The ultrasound characteristics of cancerous polyps are: larger than 10 mm; single; mostly located in the neck of gallbladder; about 50% are accompanied by gallbladder stones; the echogenic intensity of the lesion is mainly low to medium echogenicity. Radical cholecystectomy should be performed as soon as such a lesion is suspected.
Through the above explanation, we can understand in this way: there are real and fake gallbladder polyps. Pseudopolyps are not cancerous and can be observed, while true polyps have the possibility of cancer, so it is recommended to remove the gallbladder prophylactically, which can reduce the occurrence of gallbladder cancer. It is especially important to determine the authenticity of polyps.
3.How many gallbladder polyps can become cancerous?
According to statistics, only 12% of gallbladder polyps can become cancerous. In view of the fact that the better surgical efficacy of gallbladder cancer is limited to the early cancer of gallbladder mucosa, while the overall efficacy of gallbladder cancer is extremely poor, and it is not sensitive to radiotherapy and chemotherapy. Therefore, gallbladder cancer is still a very difficult disease in the medical field, and the only way to improve the treatment effect is early detection and early removal of gallbladder. This requires doctors to make a more correct and objective judgment on so many patients with gallbladder polyps – that is, to detect gallbladder cancer at an early stage and to avoid a large number of unnecessary gallbladder resections. To the extent possible, the gallbladder can be preserved in some patients. The most frightening thing about gallbladder polyps is that they can become cancerous. Doctors also believe that gallbladder polyp-like lesions are still a pre-cancerous disease and should be reviewed by ultrasound regularly to dynamically observe the changes in polyp size and shape. It should be given great attention. According to the domestic health check statistics show that: 5% of the normal population has a detection rate of gallbladder polyps. That is to say, 5% of the people in each unit of routine physical examination may be detected gallbladder polyps.
4.Is there any way to detect polyps that can become cancerous?
From the above clinical classification of gallbladder polyps and the treatment methods of different types of gallbladder polyps, we can easily see that there are real and fake gallbladder polyps, and the treatment can simply say “pseudo-polyps of gallbladder can keep the gallbladder, while real polyps have to be removed prophylactically, and polyp-like cancer has to be radically removed from the gallbladder.” However, the current medical examination cannot accurately determine the nature of polyps, so all gallbladders suspected of true polyps are removed to eliminate future problems. This inevitably results in more than half of the gallbladder being unjustly removed. One may ask: Is there any way to know the authenticity of gallbladder polyps without surgery? Is it possible to remove the polyps from the gallbladder and then sew the gallbladder back on? As we all know, the nature of tumor its highest diagnostic basis is histological diagnosis (also called pathological diagnosis). In clinical practice, biopsies are often obtained by means of percutaneous puncture or endoscopic biopsy. However, the gallbladder is a blind pouch-like hollow organ that stores bile, and it does not have a natural cavity for endoscopic access, nor can it be percutaneously punctured, so we cannot obtain the tissue. And all kinds of examination means can only describe the polyp shape, and these shape descriptions can only be used as a reference, not as a clinical guide. Therefore, it becomes impossible to obtain the nature of the gallbladder polyp without wanting to go through surgery. If we were to remove the gallbladder from the portion of the patient for whom surgery is recommended, the tissue of the polyp would be retrieved during surgery and a rapid frozen biopsy would be performed. This is a new treatment method obtained in a rigorous manner, which preserves part of the functional gallbladder and removes the gallbladder with cancerous tendency. Can the current medical level reach this vision? The answer is yes, there is indeed such a method, which we call “laparoscopic choledochoscopy combined with biliary polyp removal biopsy”. It is a laparoscopic approach to understand the abdominal cavity and the appearance of the gallbladder, to determine whether the gallbladder is normal and whether there are cancerous lesions in the abdominal cavity, and then to clip the bottom of the gallbladder and drag out a small part of it to the outside of the abdominal wall incision under the direct view of the laparoscope. If the polyp is reported as benign such as cholesterol, then we will try our best to remove the polyp and then close the small opening of the gallbladder. The gallbladder is then kept in your body. The technique of this procedure is quite mature and there are few serious complications. However, it is controversial in the medical community because it does not change the internal environment of the gallbladder and recurrence of polyps will be impossible to avoid. Therefore, when you have gallbladder polyps, your doctor will give different advice during your visit. This is something that I hope you can understand.
5. Is it necessary to keep the gallbladder for benign diseases of the gallbladder?
In terms of modern medical physiology, there is also a strong theoretical basis. It is just a pity that modern Western medicine has not been able to find a better alternative to cholecystectomy in the more than 120 years since the birth of cholecystectomy. As a result, for the last century, Chinese people have been suffering from having to destroy the body that originated from their parents. Of course, the significance of preserving the gallbladder is a bit biased purely in terms of traditional culture. However, the patient’s strong desire to preserve the gallbladder can be rooted in the culture. Currently we are able to observe the appearance of polyps in the gallbladder through choledochoscopy to make an accurate determination of true and false polyps. And we can remove the polyps for rapid biopsy and ultimately decide on the retention of the gallbladder based on the pathological results. In this way, we are able to preserve the gallbladder with pseudo-polyps and remove the gallbladder with true polyps, which can relieve the worries of gallbladder cancer and preserve the normal gallbladder at the same time. In this way, a part of the gallbladder can be preserved without increasing the patient’s pain and cost, which is a concrete manifestation of humanistic medicine. Therefore, I think it is still necessary to preserve the gallbladder appropriately.
6. Comparison of recommendations for the treatment of gallbladder polyps: The guiding recommendations of surgical textbooks for gallbladder polyps are
(1) Observation.
Multiple polyps in the gallbladder with a diameter of 1.0 cm or less without symptoms should be reviewed by ultrasound regularly to dynamically observe changes in polyp size and shape.2 Prophylactic cholecystectomy.
(2) Prophylactic cholecystectomy.
① 1 solitary polyp.
(ii) Those larger than 1.0 cm wide base or wide base.
(③) Those with enlarged lesions.
④ Combined with gallbladder stones.
⑤ Those aged 50 years or older with symptoms. All of the above can be considered as high-risk factors for malignant lesions.
Current new concepts.
(1) Observation (content as above).
(2) Pseudopolyps should be preserved, and true polyps should be performed prophylactic cholecystectomy.
With the continuous development of modern diagnostic imaging technology and the national emphasis on national health vigorously advocate health checkups, the number of gallbladder polyps detected is increasing, and gallbladder polyps have become one of the most common biliary tract diseases. However, there have been some debates or differences on how gallbladder polyps should be treated. First, there are no drugs targeting strong gallbladder polyps to prevent and treat them. For polyps less than 10mm, no treatment can be done and it is recommended to review ultrasound every three to six months to monitor the dynamics of gallbladder polyp size. For polyps approaching or exceeding 10 mm, prophylactic cholecystectomy is recommended, with laparoscopic cholecystectomy (LC) being the first choice. If the patient has a desire to preserve the gallbladder and is under 60 years of age and meets the criteria for prophylactic gallbladder removal, a combined laparoscopic biliary choledochoscopy with biliary polyp removal biopsy can be tried for this group of patients. In this way, the gallbladder of some patients can be preserved to the greatest extent possible.
To sum up, gallbladder polyps are really not terrible, and it is certainly self-seeking to worry about them, and it is certainly not right to leave them alone. Only a scientific and objective approach to gallbladder polyps is the wisest choice.