GALL BLADDER POLYPS

1. GALL BLADDER POLYPS Dr.Thomas Joseph

2. GB polyp is the term used to describe any mucosal projection into the lumen of Gall bladder • Frequency ranges from 1 to 4% • Neoplastic or non-neoplastic • Non neoplastic lesions account for about 95% of the polyps

3. Pathology • Cholesterol polyps • Adenomyoma • Inflammatory polyps • Adenomas • Miscellaneous polyps

5. Cholesterol polyps • Most common type of GB polyps • Variant of cholesterolosis • Typically small (<10mm) • Pedunculated • Usually multiple

6. Adenomyoma • Adenomyomatosis of the gall bladder localized to the fundus • Hemispheric bulge into the lumen • Usually single

7. Adenomas • Neoplastic polyps • Usually single • Can be located anywhere in GB • Multiple in one third • Sometimes innumerable tiny mucosal polyps-multicentric papillomatosis • Co-exists with stones in half the cases

8. Two histologic forms-papillary and non papillary • In papillary form there are branching tree like skeleton of connective tissue covered with tall columnar cells • In non papillary form there is a proliferation of glands encased by fibrous stroma

9. Adenomas have premalignant potential • Frequency of progression from adenoma to carcinoma is much lower than that for colonic polyps • Virtually all adenomas with focus of carcinoma are more than 12 mm in diameter

10. Inflammatory polyps • Solitary in half the cases • Small sessile lesions consisting of granulation and fibrous tissue infiltrated with lymphocytes and plasma cells

11. Miscellaneous Polyps • Fibromas • Leiomyoma • Lipoma • Neurofibroma • Carcinoids • Heterotropic gastric glands • Peutz Jegher’s syndrome • Usually single

12. Clinical features • Usually asymptomatic • May detach and behave like a stone • Biliary colic • Bile duct obstruction • Pancreatitis • Rarely cause acalculous cholecystitis or hemobilia

13. Diagnosis • Usually an incidental finding on USG • Lesion inside the gall bladder without acoustic shadow • Will not change much with position • Size of more than 10mm predicts the risk of malignancy

15. EUS improves diagnostic accuracy • 97% accurate in predicting benign nature • Tiny echogenic spots or aggregates of echogenic spots suggest Cholesterolosis • Multiple microcysts or comet tail artefact suggest Adenomyomatosis

16. 18 flurodeoxyglucose PET scan – uptake predicted the presence of malignancy • Colour Doppler • Presence of colour signal • Diffuse and arborizing pattern • Blood flow velocity • Resistive index • CT/CT biliary cystoscopy

17. Treatment • Patients with biliary colic and USG showing both stones and polyps should undergo cholecystectomy • If USG shows only polyps – decision depends on severity of symptoms and size of polyps

18. Asymptomatic polyps less than 10mm can be followed up by USG • Lesions between 10mm and 18mm should undergo laproscopic cholecystectomy if the patient is an acceptable surgical candidate • If poor surgical risk  follow up by USG or cholecystography every 6 to 12 months

19. Lesions more than 18 mm should be operated • Preferably open cholecystectomy

20. Thank You