Jang Sung Ill, Cho Jae Hee, Lee Dong Ki
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2020 Sep 25;76(3):102-107. doi: 10.4166/kjg.2020.76.3.102.
A gallbladder (GB) polyp is an elevation of the GB mucosa that protrudes into the GB lumen. GB polyps have an estimated prevalence of 0.3-9.5% and can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps). Pseudopolyps are most commonly cholesterol polyps but also include focal adenomyomatosis and inflammatory polyps with no malignant potential. Neoplastic polyps, however, can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are usually adenocarcinoma. Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling GB polyps. On the other hand, because it is difficult to diagnose GB polyps before surgery, alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated. The current guidelines recommend cholecystectomy for GB polyps ≥ 10 mm in size as well as suboptimal sized GB polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms. The quality of the evidence behind this practice is relatively low. Therefore, this review identifies the current gaps in the available evidence and guidelines and introduces methods that can help make decisions regarding patients who require a cholecystectomy or follow-up.
胆囊息肉是胆囊黏膜向胆囊腔内突出的隆起。胆囊息肉的估计患病率为0.3%-9.5%，可分为肿瘤性（真性）息肉和非肿瘤性息肉（假性息肉）。假性息肉最常见的是胆固醇息肉，但也包括局灶性腺肌增生症和无恶性潜能的炎性息肉。然而，肿瘤性息肉可能是良性的，也可能是恶性的。良性息肉最常见的是腺瘤，而恶性息肉通常是腺癌。经腹超声检查是诊断和监测胆囊息肉的主要影像学方法。另一方面，由于术前难以诊断胆囊息肉，正在进一步评估其他成像方式，如内镜超声。目前的指南建议，对于直径≥10mm的胆囊息肉以及有其他危险因素（包括年龄>50岁、基底较宽、有症状）的尺寸不太理想（6-9mm）的胆囊息肉，应进行胆囊切除术。这种做法背后的证据质量相对较低。因此，本综述确定了现有证据和指南中目前存在的差距，并介绍了有助于对需要进行胆囊切除术或随访的患者做出决策的方法。
