SURGICAL INDICATIONS FOR SMALL POLYPOID LESIONS OF THE GALLBLADDER

BACKGROUND: TO determine which polyps of the gallbladder should be ope rated upon, we investigated the size and number of polyps in resected gallbladders, and studied changes in gallbladder polyps using ultrason ography (US). METHODS: We studied 74 resected gallbladders with small polypoid lesions less than 20 mm in diameter, and 60 patients with gal lbladder polyps by US. The polyps in resected gallbladders were classi fied into four groups histologically, and clinical features, maximum d iameter, and number of lesions were compared among the groups. In the followed-up cases with gallbladder polyps, the size and number of poly ps were examined by US, and changes during the observation period were studied. RESULTS: The mean diameter of adenoma was 6.00 +/- 3.39 mm ( mean +/- SD) and that of cancer 10.8 +/- 4.16 mm; 97% of cholesterol p olyps were less than 10 mm in diameter (3.66 +/- 2.68 mm). Neoplastic polyps tended to be single (adenoma, n = 1.40 +/- 0.89; cancer, n = 1. 16 +/- 0.40), whereas half of the cholesterol polyps were multiple (n = 3.09 +/- 3.31). However, when there were fewer than 3 lesions, the i ncidence of neoplasm was 37% among polyps 5 to 10 mm in diameter. A lo w incidence (6%) of neoplasm was also observed among polyps less than 5 mm in diameter. CONCLUSIONS: These data indicate that an aggressive surgical approach for small gallbladder der polyps is warranted when t here are fewer than 3 polyps, regardless of their size. (C) 1998 by Ex cerpta Medica, Inc.