Table 2 Updated guidelines issued by different associations on the management of gallbladder polyps

Branch of Biliary Surgery, Chinese Surgical Society;

Chinese Committee of Biliary Surgeons [50]

Gallbladder polyps with malignant tendency have the following characteristics:

(1) diameter ≥ 10 mm;

(2) combined with gallstones or cholecystitis;

(3) solitary or sessile polyps with a growth rate > 3 mm/ 6 months;

(4) adenomatous polyps.

The Japanese Society of Hepato-Biliary-Pancreatic Surgery [51]

For polypoid lesions of the gallbladder that are sessile, have diameters equal to or greater than 10 mm, and/or grow rapidly, prophylactic cholecystectomy should be performed.

ESGAR, EAES, EFISDS and ESGE [52]

1. Cholecystectomy is recommended for:

(1) polyps ≥ 10 mm in diameter as detected on transabdominal ultrasound;

(2) polyps < 10 mm in diameter but with symptoms due to the gallbladder;

(3) polyps between 6–9 mm in diameter and the patient has one or more risk factors such as age > 60 years, primary sclerosing cholangitis, asian ethnicity and sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm).

2. If a patient has a risk factor, the presence of a solitary polyp strengthens the evidence that malignant potential exists, and cholecystectomy should be considered.

3. If during follow-up the gallbladder polypoid lesion reached 10 mm cholecystectomy is advised; if the polypoid lesion grows by 2 mm or more within the 2-year follow-up, its current size should be considered along with patient risk factors.

China Anti-cancer Association [53]

1. For patients with gallbladder polypoid lesions who have clinical symptoms such as right upper abdominal discomfort after eating, if the polyps are ruled out as cholesterol crystals in the gallbladder through effective imaging examinations, or the symptoms are not relieved after choleretic treatment, cholecystectomy is recommended regardless of the size of lesion.

2. For asymptomatic gallbladder polypoid lesions, cholecystectomy is recommended if the following conditions exist:

(1) the lesion is combined with gallstones;

(2) the largest diameter of the lesion exceeds 10 mm (CT, MRI, endoscopic ultrasonography or contrast-enhanced ultrasound);

(3) the base of lesion is wide;

(4) the lesion is thin-stalked, intracapsular growth with good blood supply, and the polyp is clearly enhanced by enhanced CT examination;

(5) the lesion is located in the neck of the gallbladder or near the opening of the cystic duct.

3. For those with asymptomatic gallbladder polypoid lesions who do not yet have indications for surgery, regular follow-up and examinations should be performed. Cholecystectomy is recommended when the following conditions are present:

(1) age is over 50 years old;

(2) the polyp has a maximum diameter of less than 8 mm, but compared with the imaging results (CT or MRI) within one year, it indicates that the lesion has grown significantly.

(3) the polyp has a diameter of 6 mm, and enhanced CT examination shows that the blood supply is good.

Society of Radiologists in Ultrasound [54]

If the gallbladder polyp seen on ultrasound does not meet exclusion criteria, its risk level can be determined by the morphology and the size.

1.Extremely low risk: pedunculated ball-on-the-wall or pedunculated with thin stalk

(1) ≤ 9 mm: no follow-up;

(2) 10–14 mm: follow-up ultrasound at 6,12,24 months;

(3) ≥ 15 mm: surgical consult.

2.Low risk: pedunculated with thick or wide stalk or sessile

(1) ≤ 6 mm: no follow-up;

(2) 7–9 mm: follow-up ultrasound at 12 months;

(3) 10–14 mm: follow-up ultrasound at 6,12,24,36 months vs. surgical consult;

(4) ≥ 15 mm: surgical consult.

3.Indeterminate risk: focal wall thickening ≥ 4 mm adjacent to polyp

(1) ≤ 6 mm: follow-up ultrasound at 6,12,24,36 months vs. surgical consult;

(2) ≥ 7 mm: surgical consult.