Published in:
01-05-2015 | Systematic Review and Meta-analysis
Management and diagnosis of gallbladder polyps: a systematic review
Published in: Langenbeck's Archives of Surgery | Issue 4/2015
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Purpose
Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs.
Methods
MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points.
Results
Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32–83). Patients with malignant GBPs had an average (range) age of 58 (50–66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5 % of GBPs followed by adenomas (15.2 %) and cancer (11.6 %). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0 % of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy.
Conclusions
Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following:
1. Surveillance may not be needed for GBPs <5 mm.
2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years.
3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.