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Surveillance program for gallbladder polyps potentially beneficial, cost-effective

Ultrasonographic surveillance of gallbladder polyps, with or without subsequent surgery, would be cost-effective while aiding in the detection and prevention of gallbladder cancer, according to recent results.

Researchers evaluated data from 986 patients with gallbladder polyps detected via ultrasonography. Incorporated information included patient demographics, polyp size, number and changes in size, histological findings and the number and duration of performed scans.

Across the cohort, 467 patients underwent either treatment or surveillance. The majority of polyps did not change in size (67.7%), while 6.6% increased during this period. Polyps that grew were significantly larger upon presentation than those that showed no change (7 mm in diameter compared with 5 mm, P<.05). A diameter of more than 10 mm (median 10 mm among malignant/potentially malignant polyps vs. 5 mm among benign, P<.001) and growth during surveillance (100% vs. 19% of polyps, P<.001) were found to be predictive of neoplasia or potential neoplasia.

Among 134 patients who underwent surgery, malignant or potentially malignant neoplasia was present in 3.7% of gallbladders, including one incident of invasive cancer. The most common histological findings among surgery patients included associated chronic cholecystitis (56.0% of patients), cholesterol polyps/adenomyomatosis (41.0%) and stone disease (16.4%).

Using study data, investigators calculated the detection rate for neoplastic/potentially neoplastic polyps at 10.7 per 1,000 among the 467 patients who received follow-up. This figure was equated with 5.4 cancers detected in the general population annually, assuming all neoplastic polyps become malignant. The researchers then estimated that, at this rate of detection, a surveillance program with or without selective resection would save a net minimum of $207,839 each year per 1,000 patients, and that these savings could be improved by incorporating a monthly scan model and limiting surveillance to polyps larger than 5 mm at presentation.

“Polyps between 5 and 10 mm should be under [ultrasonography] surveillance,” the researchers concluded. “Special considerations for early cholecystectomy could be made for the young or high-risk groups. Polyps greater than 10 mm or exhibiting an increase in size should be removed. All gallbladder polyps represent potentially premalignant disease and require discussion … because this would enhance and standardize the management of this condition.”