Differential diagnosis of large-sized pedunculated polypoid lesions of thegallbladder by endoscopic ultrasonography: a prospective study

Purpose. We have previously reported the effectiveness of endoscopic ultras onography (EUS) for the differential diagnosis of pedunculated polypoid les ions of the gallbladder, based on retrospective studies using resected spec imens. We proposed the following diagnostic criteria for EUS findings: when the contour of a lesion is nodular or smooth, the lesion is diagnosed as a neoplasm, and when a lesion has a granular contour, it is diagnosed as a n onneoplasm. The present study was designed to verify the clinical utility o f our EUS ctiteria prospectively. Methods. Forty-six consecutive patients w ith pedunculated polypoid lesions of the gallbladder 10 mm or greater in si ze diagnosed as nonneoplasms at the initial EUS, all of whom underwent foll ow-up examinations, were enrolled in this study. The occurrence of changes in these lesions during the observation period was examined. Results. No ev ident changes in lesions were observed in 43 of the 46 patients. Spontaneou s self-detachment of lesions was recognized during the observation period i n the other 3 patients. Conclusions. EUS is useful for determining treatmen t indications for pedunculated polypoid lesions of the gallbladder, even wh en the lesions are large, and contributes to avoiding unnecessary surgery.