Gallbladder disease is becoming increasingly prevalent in western Europe. The commonest form of gallbladder disease is simple gallstones, which can cause a multitude of complications. The management of gallstones is straight forward and hasn’t changed in 50 years with surgical excision recommended when stones start causing significant problems such as pain, infection or obstruction.
Management of the gallbladder becomes slightly more complicated when it is affected by other pathologies. As with gallstones, the majority of these peculiarities are diagnosed as incidental findings on scans performed for other reasons.
Gallbladder polyps are outgrowths of the gallbladder mucosal surface, that due to the advances in sophistication and access to ultrasonography, are increasingly being diagnosed. The question is what to do with these findings, and are they likely to cause long term problems?
Gallbladder polyps can cause similar symptoms to gallstones, with intermittent pain under the ribs. This is thought to be due to the polyp blocking the gallbladder. Sometimes polyps can cause atypical symptoms, so any gallbladder polyp should be investigated, and a thorough discussion should be had with your surgeon about the risks and benefits of surgery.
Decision making for asymptomatic gallbladder polyps is more difficult and is a contentious topic in the surgical community. Your general health, age and other risk factors should be taking into account before considering surgery. If they are found, it is important to discuss the option of surgery vs repeated surveillance scans over a number of years. Generally, small polyps should be scanned regularly to ensure they are stable in size and character, and bigger polyps should be recommended for surgery. However, each case should be considered on a patient specific basis.
Gallstones still remain the commonest form of gallbladder problems. However, as access to and the quality of medical imaging increases, incidental findings are becoming more frequent. Gallbladder pathologies such as polyps can cause apprehension for patients, so it is vital to make an appointment to discuss your case, and organise an appropriate management plan specific to you.
