Incidentally detected gallbladder polyps often get unneeded follow-up
Over more than two years of follow-up, gallbladder polyps increased in size in 26.0% of patients, and although cholecystectomy and follow-up imaging were commonly performed, no malignant polyps were detected, a retrospective study found.
Most gallbladder polyps detected incidentally on imaging are asymptomatic and do not need to be treated or followed long-term, a recent study found.
Researchers at the American University of Beirut Medical Center in Lebanon performed a retrospective study of patients with gallbladder polyps between January 2019 and October 2022 to evaluate typical surveillance and management, as well as the cost-effectiveness of implementing recent European guidelines. The study examined clinical, radiologic, and surgical data and assessed participation in formal surveillance programs, changes in polyp characteristics, indications for surgery, and identification of potentially malignant polyps.
The results were published May 13 by the Journal of Clinical Gastroenterology.
One hundred thirty-eight patients whose gallbladder polyps were detected on imaging were included in the study. Mean age was 47.0 years, 46.4% were female, and average follow-up was 30.6 months. Most patients (59.2%) were asymptomatic. Polyps size increased in 26.0% of patients during the study period, with no predictors of growth identified.
Thirty patients had cholecystectomy, 19 (63.3%) with gallbladder polyps as the indication, but of these, only nine (47.4%) had indications for surgery according to the European guidelines. No malignant polyps were detected and no patient deaths related to gallbladder polyps were reported. Patients whose polyps got larger during follow-up or who had a larger number of polyps were more likely to have cholecystectomy (P<0.0001 and P=0.014, respectively).
One hundred four patients did not have surgery, and of these, 70 (67.3%) had no indication for follow-up imaging. However, of these patients, 42 (60%) were still advised to continue follow-up. The authors estimated average costs at more than $51,000 for follow-up imaging inconsistent with guidelines and more than $67,000 for unindicated cholecystectomies, a total of over $118,000.
Limitations include the study's use of retrospective data from a single center and the relatively short follow-up, the study authors noted.
They concluded that their study identifies discrepancies in clinical practice for gallbladder polyps as well as the economic burden of potential unnecessary testing and procedures, “emphasizing the necessity for compliance with guidelines, as well as heightened awareness and education of health care practitioners, especially radiologists, general practitioners, gastroenterologists and surgeons who are at the forefront of diagnosis and management of a generally benign and asymptomatic condition,” they wrote. “Given the prevalence of [gallbladder polyps] in the general population, the opportunity for considerable global health care savings cannot be overemphasized.”