van Dooren Mike, de Savornin Lohman Elise A J, van der Bilt Jarmila, de Boer Marieke T, Boerma Djamila, Bos Philip, Braat Andries E, de Castro Steve M M, Corten Bartholomeus J G A, Daams Freek, Erdmann Joris I, Ferenschild Floris, Fortuin Ansje S, van Geloven Nanette, van der Hoeven Erik, Klicks Rutger, Kruyt Flip M, Langenhoff Barbara S, Liem Mike S L, Linsen Philip V M, Luyer Misha, Nieuwenhuijs Vincent B, Olthof Pim, Plaisier Peter W, van Rossem Charles, Schrauwen Ruud, Schreinemakers Jennifer, Serafino Gian Piero, Bilgen Ernst Jan Spillenaar, Talsma Koen, Tielemans Merel M, Tutein Nolthenius Charlotte J, de Reuver Philip
Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Surgery, Flevoziekenhuis, Almere, the Netherlands.
United European Gastroenterol J. 2025 Sep;13(7):1133-1140. doi: 10.1002/ueg2.70057. Epub 2025 Jul 23.
Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.
Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.
A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9-47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.
Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.
胆囊息肉在高达7%的成年人中可见，且恶性风险较低。由于恶性肿瘤发生存在地区差异，关于手术指征和随访的指南仍存在争议。本研究比较了欧洲胆囊息肉的实践指南，并评估了根据指南行胆囊切除术且术后病理证实为真性腺瘤的患者比例。
纳入2018年至2020年期间在26个参与中心对胆囊息肉进行积极随访或手术的荷兰患者。评估人口统计学、影像学特征、手术及组织病理学数据。对照2017年和2022年欧洲指南，检查所有患者的胆囊切除术指征。
共纳入302例患者。接受随访的患者平均进行了3次影像学检查，中位随访时间为23.2个月（四分位间距10.9 - 47.4个月）。共有88例患者（29%）在中位时间23个月和中位2次影像学检查后接受了胆囊切除术。在接受胆囊切除术的88例患者中，根据2017年指南，71例（81%）的胆囊息肉是胆囊切除术的有效指征；根据2022年指南，这一比例为88例中的68例（77%）。差异仅因年龄作为风险因素的变化而产生，从50岁变为60岁。在71例接受手术的患者中，49例（69%）发现为非肿瘤性息肉，23例（32%）未发现胆囊壁异常。6例患者（9%）发现腺瘤，其中3例为低级别异型增生，1例为高级别异型增生。
尽管2022年指南进行了修订，但仍有相当数量的患者因非肿瘤性胆囊息肉接受随访和胆囊切除术，这表明在胆囊息肉管理中需要更全面的风险评估算法。
