Gallbladder polyp surveillance using ESGAR guidelines

Gallbladder polyps are a very common entity. On transabdominal ultrasound (TAUS) they are present on up to 7% of studies, and cholecystectomy specimens have shown a prevalence of between 2-12%. A gallbladder polyp is defined as an elevation of the mucosa, which projects into the lumen and should not demonstrate mobility or posterior acoustic shadowing on TAUS, as these features would be more suggestive of cholelithiasis. Morphologically they may be sessile or pedunculated. Gallbladder polyps can be characterised as either true polyps or pseudopolyps (which comprise cholesterol polyps, adenomyomatosis and inflammatory polyps), and it is clinically important to differentiate between the two as the latter do not have malignant potential. On TAUS, the finding of posterior reverberation artefact indicates the presence of cholesterol crystals and, in such cases, these lesions should be characterised as pseudopolyps. Pseudopolyps constitute up to 70% of all polypoid lesions detected on TAUS. A true polyp most frequently represents an adenoma of the gallbladder wall, and these are understood to have the potential to undergo malignant transformation. The other entities that constitute true polyps include mesenchymal lesions (lipomas, leiomyomas and fibromas), neuroendocrine tumours, lymphoma and metastases; however, these are felt to be much rarer than adenomas.

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