Gallbladder Tumors Guidelines

Updated: Jun 14, 2017
  • Author: Thomas J VanderMeer, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Guidelines

ESGAR/EAES/EFISDS/ESGE Guidelines for Gallbladder Polyps

In 2017, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the European Association for Endoscopic Surgery and other Interventional Techniques (EAES), the International Society of Digestive Surgery–European Federation (EFISDS), and the European Society of Gastrointestinal Endoscopy (ESGE) issued joint guidelines regarding the management and follow-up of gallbladder polyps, [22]  which included the following:

  • For a polypoid gallbladder lesion ≥10 mm, cholecystectomy is recommended if the patient is fit for and accepts surgery (moderate-quality evidence; 89% agreement)
  • For a polypoid gallbladder lesion with symptoms attributable to the gallbladder, cholecystectomy is suggested if there is no other cause for the symptoms and the patient is fit for and accepts surgery (low-quality evidence; 89% agreement)
  • If cholecystectomy is not indicated, risk factors for gallbladder malignancy (age >50 years; history of primary sclerosing cholangitis; Indian ethnicity; sessile polyp, including focal gallbladder wall thickening >4 mm) should be established and a more intensive management plan followed (low- to moderate-quality evidence; 78% agreement).
  • If the patient has risk factors for gallbladder malignancyand a polyp 6-9 mm, cholecystectomy is recommended if the patient is fit for and accepts surgery (low- to moderate-quality evidence; 78% agreement)
  • If the patient has either (a) no risk factors for gallbladder malignancy and a polyp of 6-9 mm or (b) risk factors for malignancy and a gallbladder polyp ≤5 mm, follow-up ultrasonography (US) of the gallbladder is recommended at 6 months and 1 year and then yearly up to 5 years; If the patient has no risk factors for malignancy and a polyp of ≤5 mm or less, follow-up is advised at 1, 3, and 5 years (low-quality evidence, 78% agreement)
  • If polyp size increases by ≥2 mm during follow-up, cholecystectomy is advised (moderate-quality evidence; 78% agreement)
  • If polyp size reaches 10 mm during follow-up, cholecystectomy is advised (moderate-quality evidence; 100% agreement)
  • If the polyp disappears during follow-up, then follow-up should be discontinued (moderate-quality evidence; 100%agreement)
  • Primary investigation should be with abdominal US, and routine use of other imaging modalities is not recommended; if appropriate expertise and resources are available, other modalities (eg, endoscopic US [EUS]) may be considered as aids to decision-making in difficult cases (low-quality evidence; 100% agreement)