Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study.

IF 6.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

United European Gastroenterology Journal Pub Date : 2025-09-01 Epub Date: 2025-07-23 DOI:10.1002/ueg2.70057

Mike van Dooren, Elise A J de Savornin Lohman, Jarmila van der Bilt, Marieke T de Boer, Djamila Boerma, Philip Bos, Andries E Braat, Steve M M de Castro, Bartholomeus J G A Corten, Freek Daams, Joris I Erdmann, Floris Ferenschild, Ansje S Fortuin, Nanette van Geloven, Erik van der Hoeven, Rutger Klicks, Flip M Kruyt, Barbara S Langenhoff, Mike S L Liem, Philip V M Linsen, Misha Luyer, Vincent B Nieuwenhuijs, Pim Olthof, Peter W Plaisier, Charles van Rossem, Ruud Schrauwen, Jennifer Schreinemakers, Gian Piero Serafino, Ernst Jan Spillenaar Bilgen, Koen Talsma, Merel M Tielemans, Charlotte J Tutein Nolthenius, Philip de Reuver

{"title":"Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study.","authors":"Mike van Dooren, Elise A J de Savornin Lohman, Jarmila van der Bilt, Marieke T de Boer, Djamila Boerma, Philip Bos, Andries E Braat, Steve M M de Castro, Bartholomeus J G A Corten, Freek Daams, Joris I Erdmann, Floris Ferenschild, Ansje S Fortuin, Nanette van Geloven, Erik van der Hoeven, Rutger Klicks, Flip M Kruyt, Barbara S Langenhoff, Mike S L Liem, Philip V M Linsen, Misha Luyer, Vincent B Nieuwenhuijs, Pim Olthof, Peter W Plaisier, Charles van Rossem, Ruud Schrauwen, Jennifer Schreinemakers, Gian Piero Serafino, Ernst Jan Spillenaar Bilgen, Koen Talsma, Merel M Tielemans, Charlotte J Tutein Nolthenius, Philip de Reuver","doi":"10.1002/ueg2.70057","DOIUrl":null,"url":null,"abstract":"Background: 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.Methods: 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.Results: 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.Discussion: 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.","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1133-1140"},"PeriodicalIF":6.7000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463707/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"United European Gastroenterology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ueg2.70057","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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.

Discussion: 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.

查看原文本刊更多论文

修订后的胆囊息肉治疗和随访指南不能减少不必要的胆囊切除术：息肉研究的结果。

背景：胆囊息肉在成人中发病率高达7%，其恶性风险较低。由于恶性肿瘤发展的地区差异，手术适应证和随访指南仍存在争议。本研究比较了欧洲胆囊息肉的实践指南，并评估了根据指南进行胆囊切除术的患者术后真腺瘤的百分比。方法：纳入2018年至2020年期间在26个参与中心进行胆囊息肉积极随访或手术的荷兰患者。统计数据，影像学特征，手术和组织病理学进行评估。比较2017年和2022年欧洲指南，检查所有患者的胆囊切除术指征。结果：纳入302例患者。随访患者接受3次影像学检查（中位），中位随访时间为23.2个月（IQR 10.9-47.4）。共有88名患者（29%）在中位时间为23个月和中位两次影像学检查后接受了胆囊切除术。根据2017年指南，88名接受胆囊切除术的患者中有71名（81%）胆囊息肉是胆囊切除术的有效指征，而根据2022年指南，88名患者中有68名（77%）胆囊息肉是胆囊切除术的有效指征。这种差异仅仅是由于年龄作为一个风险因素在50岁到60岁之间发生了变化。71例手术患者中，非肿瘤性息肉49例（69%），胆囊壁未见异常23例（32%）。6例（9%）患者发现腺瘤，其中3例为低度发育不良，1例为高度发育不良。讨论：尽管2022年指南进行了修订，但仍有相当数量的非肿瘤性胆囊息肉患者接受随访和胆囊切除术，这表明胆囊息肉治疗需要更全面的风险评估算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

10.50

自引率

13.30%

发文量

147

期刊介绍： United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.