Gallbladder polyps are growths that project from the inner lining of the gallbladder wall. They are an increasingly common finding because high-resolution abdominal ultrasound now detects polyps that would have been invisible 20 years ago. The vast majority — over 95% — are completely benign and need nothing more than periodic monitoring. A small minority are early cancers or precancerous lesions, and surgery in this group can be life-saving. Sorting one from the other is one of the most useful things a General Surgeon does. As a female specialist laparoscopic surgeon at Medcare Hospital Al Safa, Dr. Vanesha Varik regularly reviews patients sent in with “a polyp on ultrasound” who are anxious about cancer. This guide explains what gallbladder polyps are, what the international surveillance and surgery guidelines say, and how the decision to operate or observe is made.
What is a gallbladder polyp?
A polyp is any growth that projects from the inner lining (mucosa) of an organ. Gallbladder polyps look like small, fixed bumps on ultrasound — unlike gallstones, which move when you change position.
Most are picked up incidentally during an abdominal ultrasound done for unrelated reasons (back pain, fatty liver screening, abdominal discomfort).
Types of gallbladder polyp
1. Cholesterol polyps (~ 60%) — small clusters of cholesterol-laden cells. Always benign, no cancer risk. 2. Inflammatory polyps (~ 10%) — chronic inflammation. Always benign. 3. Adenomyomatosis (~ 25%) — thickening of the gallbladder wall, usually benign. 4. Adenomas (~ 4%) — true neoplastic polyps; small risk of progressing to cancer. 5. Adenocarcinoma (~ 1%) — cancer of the gallbladder.
The challenge is that ultrasound cannot reliably tell these apart — the decision is based on size, shape, growth, and risk factors.
What raises the cancer risk
- •Size ≥ 10 mm
- •Single, sessile (broad-based) polyp on ultrasound
- •Age over 50
- •Coexisting gallstones
- •Indian or Asian ethnicity
- •Primary sclerosing cholangitis
- •Rapid growth on follow-up scans
International guidelines (ESGAR/ESGE 2022)
Surgery is recommended (laparoscopic cholecystectomy) for:
- •Polyp ≥ 10 mm
- •Polyp 6–9 mm with any risk factor
- •Polyp causing symptoms
- •Rapid growth (≥ 2 mm in 6 months)
- •Suspicious imaging features
Surveillance ultrasound is recommended for:
- •Polyp < 6 mm: ultrasound at 1, 3 and 5 years; stop if stable.
- •Polyp 6–9 mm without risk factors: ultrasound at 6 months, then yearly for 5 years.
No surveillance needed for: cholesterol polyp pattern (multiple, < 5 mm, classic ‘starry sky' appearance).
What surgery involves
Treatment is the same as for gallstones — laparoscopic cholecystectomy:
- •4 small incisions, 30–60 minute operation
- •Day-care discharge in most elective cases
- •1–2 week recovery
- •Removed gallbladder is sent for full histopathology to confirm the polyp type
What if cancer is found unexpectedly?
In the rare case (~ 1%) where histopathology shows early cancer:
- •T1a (mucosa only) — laparoscopic cholecystectomy alone is sufficient; cure rate > 95%
- •T1b or deeper — referral for extended liver resection and lymph node clearance This is why all gallbladder specimens are routinely sent for histology, even when the indication is benign.
How we approach polyps at Medcare
1. Review the original ultrasound images carefully — repeat scan with a senior radiologist if needed. 2. Risk-stratify by size, number, shape, growth and patient factors. 3. Recommend surveillance vs surgery using ESGAR 2022 guidelines. 4. For surgery, perform standard laparoscopic cholecystectomy with full histopathology. 5. Long-term follow-up by histology result.