Do Gallbladder Polyps Need To Be Removed

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• Published: eighteen March 2022

Gallbladder polyps – a follow-up written report afterwards 11 years

BMC Gastroenterology book nineteen, Article number:42 (2019) Cite this commodity

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Abstruse

Background

The aim of our report was to investigate the prevalence and natural long-term progression of gallbladder polyps in a random sample of the general population.

Methods

Iv hundred and 13 subjects (190 women, 223 men; anile 29–75 years) were studied first in 2002 and once more eleven years later in 2022. All subjects were interviewed using a standardised questionnaire, anthropometric information were recorded, and an abdominal ultrasound browse was carried out.

Results

The prevalence of gallbladder polyps was 6.1% (115/1880) in the 2002 study and 12.1% (l/413) in the 2022 follow-up study. After xi years, 36 subjects (viii.7%, 36/413) had developed new polyps, xiii subjects (48.1%, thirteen/27) no longer had gallbladder polyps, and fourteen subjects (51.9%, fourteen/27) still had polyps. The number of polyps had increased in vi of these subjects (43%, 6/xiv), decreased in a further half-dozen (43%, 6/14), and remained unchanged in two (14%, ii/14). The hateful polyp size was 4.vii mm (± two.2 mm, range 2–xx mm) in 2002 and 4.0 mm (± one.9 mm, range 0.5–xi mm) at follow-upwardly. A decrease in polyp size was noted in seven (l%) of the 14 subjects, an increase in size in five subjects (35.7%), and no modify in 2 subjects (14.three%). The shape of the polyps had changed from pedunculated to sessile in two subjects (14.3%, 2/14) and from sessile to pedunculated in one field of study (7.1%, ane/14).

Conclusions

In long-term follow-up, the prevalence of gallbladder polyps increased, with new lesions developing in 8.vii% of the population. Polyps persisted in 51.9% of the subjects who had them in the original study and disappeared in the other 48.1%.

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Background

Gallbladder polyps are a common incidental finding on abdominal ultrasonography [i, 2]. The growth and management algorithm of small polyps measuring less than 10 mm remained unclear for a long time [i, iii, 4]. In 2022 there were established current guidelines on the treatment and follow-up of gallbladder-polyps [5]. Earlier studies accept given very different figures for prevalence, ranging from 0.32 to 26.five% [half dozen, 7]. This discrepancy tin can be attributed mainly to the differences in written report populations and written report designs, which greatly restrict the possibilities of comparing. Ultrasound studies on random population samples in Deutschland have given prevalences of 1.4 and six.1% [8, ix].

At the present time, only a express number of studies addressing the long-term progression of gallbladder polyps in not-selected populations are available [ii, 3, 7,eight,9,10,11,12,13,14,xv,16,17,eighteen,nineteen,20]. One follow-up study in a random population sample over an observation menses of 30 months showed that 81% of the polyps did not change in size, while 14% had increased and 5% had decreased. At follow-upward, gallbladder polyps were no longer demonstrated in 23% of the subjects [8]. Later 84 months, 77% of the polyps investigated were the same size, while 8% had become smaller [8].

The aim of our study was to investigate the prevalence and natural long-term progression of gallbladder polyps in a random sample of the general population.

Methods

The original Echinococcus multilocularis in Leutkirch (EMIL) study in the general population was carried out in 2002 [21]. In that yr, 4000 people anile between 10 and 65 years randomly selected from the residents' registration office in Leutkirch were contacted for the study, of whom 2445 subjects formed the written report population. In 2022, following data analysis and matching cases and controls according to gender, age, body mass index (BMI), and the presence or absence of hepatic steatosis, we recruited a subpopulation of 484 out of the original EMIL subjects for the follow-up study. After persons with incomplete datasets had been excluded, we ultimately had an EMIL subpopulation of 413 subjects anile between 29 and 75 years taking part in the follow-up study (Fig. 1). Participation was voluntary. The follow-up study population consisted of 190 (46%) women and 223 (54%) men (Table 1). Using a standardised questionnaire, nosotros asked the subjects about personal details, leisure activities, past medical history, dietary habits, smoking, alcohol consumption and recreational drug use, and family unit history. Elevation and weight were measured on the spot. Each subject had an ultrasound scan of the upper abdomen. The gallbladder was measured in three planes, the wall was described as unremarkable or thickened (thickening > 3 mm), and the lumen examined for sludge, stones and polyps. If stones or polyps were detected, we documented the number, site, maximum size in 3 planes, presence of acoustic shadowing, echogenicity, shape, and contours. Further examinations such equally computed tomography scanning or histological assay have not been performed. It isn't known whether subjects underwent cholecystectomy in the course.

Fig. 1

Flow chart showing the inclusion and exclusion of subjects in the gallbladder polyp study from the random sample of the full general population (EMIL-I study in 2002 and follow-up EMIL-II written report in 2022)

Full size image

Table 1 Subject area characteristics (northward = 413)

Full size table

The statistical analysis was performed with SAS Version 9.ii. Dichotomous variables too as variables on ordinal and nominal scales were first presented descriptively. After the presentation of sites and extent of distribution, we calculated the age-specific and gender-specific prevalence rates.

Results

Prevalence of gallbladder polyps

The prevalence of gallbladder polyps was half-dozen.i% (115/1880 subjects) in the original 2002 study: 6.two% for women and 6.0% for men. In that location was a tendency towards an increasing prevalence of polyps with historic period, although the charge per unit was already somewhat elevated in the grouping aged 31–xl (Fig. 2).

Fig. 2

Relative frequency of gallbladder polyps according to age in the original EMIL written report in 2002 and the follow-up study in 2022

Total size image

In the 2022 follow-upward study, the prevalence was 12.1% (l/413 subjects) with women and men existence affected in relatively equal proportions (12.i%). The highest prevalence was seen in the 31–40 age group, but there was also an upwards trend with increasing historic period in the older age groups (Fig. 2). The mean historic period of the accomplice (n = 413) was 57.8 ± xi.vii years. The youngest person was 31 years of age and the oldest 74. There were 23 subjects (5.6%) in the 31–40 age group and 124 (30.0%) in the over-65 due south. Most of the patients (167; 40.4%) were aged 51–65 years. The hateful BMI (torso mass index) was 29.two ± 4.three, ranging from xx.seven to 41.i (Tabular array 1).

Progression of gallbladder polyps

In the 2022 follow-up report, nosotros examined 27 subjects who had already had gallbladder polyps in 2002. 14 of these subjects (51.9%) notwithstanding had polyps, while xiii subjects (48.1%) no longer had whatsoever evidence of gallbladder polyps on ultrasound scanning. In add-on, 36 subjects (eight.7%) who did not have polyps in 2002 had adult them by 2022.

The natural progression of gallbladder polyps could be observed in the 14 patients who had polyps in the original study in 2002 and besides participated in 2022 (referred to in the following as 'follow-upwardly subjects'). The number of polyps increased in six subjects (42.9%), decreased in a further six subjects (42.9%), and was unchanged in the remaining two (14.3%). Polyp size decreased in seven subjects (50.0%), increased in five subjects (35.7%), and stayed the same in the other two (fourteen.three%).

Ultrasound scan characteristics

In full general, the majority of polyps were hyperechoic. Over time, the echogenicity had inverse from hyperechoic to hypoechoic in one subject. Table 2 shows the observations made in the 14 follow-upwardly subjects with respect to the shape of the polyps. In viii of the 14 subjects (57.ane%) the polyps had not changed in shape. The description of the polyps had inverse from pedunculated to sessile in two subjects (14.3%) and vice versa from sessile to pedunculated in one subject field (vii.one%). In two cases, polyps identified in 2022 were described equally pedunculated, although it had not been possible to appraise them in the original 2002 study. One polyp, reported as pedunculated in the original written report could not exist assessed in 2022. The gallbladder polyps more often than not showed regular contours but had become irregular in two of the subjects in the follow-upward group.

Table two Progression of the gallbladder polyps within the follow-up group (14 patients with gallbladder polyps on examination in 2002 and 2022)

Full size tabular array

Discussion

In comparison with other population-based studies, the EMIL follow-upwardly study in 2022 showed a higher prevalence (12.1%) of gallbladder polyps. Well-nigh of the before population-based studies come from Asia [22,23,24,25,26,27]. Population-based studies from Germany have and so far yielded prevalences of one.4% (incidental findings when ascertaining the prevalence of gallbladder stones) and half dozen.i% [8, 9]. In Europe, apart from these High german studies, only Jørgensen in Denmark has adamant population-based prevalences of 4.6 and 4.3% in the up to 60-twelvemonth-onetime men and women, respectively, and of v.9 and 5.8% in seventy-year-old men and women [28, 29]. Comparing the population-based studies worldwide, a general increase in the prevalence can be seen over the years from 1990 to date: Jørgensen (1990) iv.6%/iv.3%, Segawa (1992) five.6%, Chen (1997) 6.ix%, Okamoto (2002) 8.1%, Kratzer (2010) 6.one%, Park (2013) 8.five% and EMIL (2013) 12.i% [9, 22, 24,25,26,27,28,29]. In the first instance, this increase may be due to improvements in the ultrasound technology.

Autonomously from the general population-based studies, there have been many studies on selected populations, for instance, during healthcare screening [xvi, 27, 30,31,32], oil industry workers in China [33], officers aged betwixt 48 and 56 years in Japan [34], and patient populations [ii, 6, xv, 35,36,37]. While population-based studies have given prevalences in the range of 1.four to 8.5% – and 12.1% in the EMIL follow-upwardly study – studies on selected subjects have given values between 6.one and 12.3%, while studies on patient populations have given values of 0.06 to 26.v%. The majority of the values obtained take been below vii% [ii, half dozen,7,8,9, 12, 14,15,16, 22,23,24,25,26,27,28,29,30,31, 33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66]. The large differences in the results may be attributed in function to different written report designs and methods. Previous prevalence information obtained past ultrasound ranged from 0.32 to 9.96%; data obtained by surgery and pathology were between 0.06 and 21.3% and tended to exist somewhat higher than the ultrasound data [2, vi, 8, 9, 12, xv, 16, 22,23,24,25,26,27,28,29,30,31, 33,34,35,36,37,38,39,xl,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66]. This departure may demonstrate the fact that not all existing polyps were detected on ultrasound scans in the by, as the technology was not so highly adult. The results of the EMIL follow-up, with 12.i%, are in the same order of magnitude every bit the surgical/pathological results. For instance, Toda et al. found a polyp prevalence of 14.eight% and the report by Furukawa et al. gave a corresponding figure of ten.four% [42, 63].

In the EMIL report, nosotros did not find a gender-specific difference in the prevalence of polyps. Csendes and co-workers, as well as Cantürk et al. also found the prevalence to be similar in men and women [3, 35]. In our study, the 31–xl age group showed the highest prevalence at 17.4%. In the original study, too, the group anile 31–40 at that fourth dimension had a higher prevalence than the post-obit historic period group. Lin and co-workers reported an increased frequency of gallbladder polyps in 41 to 50-twelvemonth-olds [31]. Hayashi et al. found the highest prevalence in 40 to 49-twelvemonth-erstwhile men and l to 59-year-sometime women [30]. The presence of gallbladder polyps therefore particularly affects middle-anile people. I explanation for the reduced prevalence of polyps in the older age groups compared with the middle-aged group may be the simultaneous occurrence of gallstones, which peradventure leads to the automatic removal of the polyps [32, 35].

In total, 27 subjects with gallbladder polyps from the original study in 2002 were also examined in 2022: polyps were all the same present in 14 (51.9%) of these subjects but were no longer to be found in 13 (48.ane%). Corwin et al. determined a similarly high proportion of polyps that had disappeared (34%) in their follow-up report later 65 months [xiii]. One German written report showed that 22.half-dozen% of the polyps had disappeared after xxx months [8], while the follow-up study past Csendes et al. found that 18% of gallbladder polyps could no longer be demonstrated subsequently 48 months [3].

The mean size of the polyps in our xiv follow-up-subjects was slightly larger in 2022 (4.7 ± ane.9 mm) than in 2002 (4.1 ± 1.one mm) [9]. Collett and Choi et al. as well published results showing a maximum growth of almost 1 millimetre [12, 32]. Just every bit fewer polyps (35.7%) had increased in size and a greater proportion (50%) had reduced in size in the EMIL report, studies carried out in England past Cairns et al. and Corwin et al. showed a similar picture [10, 13]. Virtually other follow-upwardly-studies take shown that the bore does non change in the majority of polyps. For example, Park et al. plant 75% unchanged, 15% enlarged and 10% decreased in size [16]. Colecchia and co-workers reported polyps that were 91% unchanged, 5.seven% enlarged and 3.viii% decreased in size [eleven]. In contrast, Wolpers published findings showing that in subjects with multiple polyps only 11% remained unchanged subsequently a period of well-nigh vii years: 28% had grown and 13% had shrunk [7]. The EMIL follow-up written report in 2022 also showed a college proportion of multiple gallbladder polyps. These correlations let us to conclude that the modest number of subjects with unchanged gallbladder polyps could simply be due to the larger number of polyps per subject.

At the cease of the follow-up period in the EMIL study, the number of gallbladder polyps was the same in merely 2 subjects (fourteen.iii%). Half of the remaining follow-upward subjects had more (42.nine%) gallbladder polyps in 2022 while the other half (42.9%) had fewer polyps. Other follow-up-studies – provided that data on the number of polyps over time are available – have shown an increase rather than a decrease in the number of polyps [3, 7, 10]. Wolpers, for instance, reported an increase in number in 21% of subjects with multiple polyps compared with a reduction in number in 14% [7]. After 48 and 96 months, Csendes et al. found an increment in 20 and 24% of subjects, respectively, while the corresponding figures for a reduction in the number of polyps were just 6 and 3% [3].

Observation of the gallbladder polyps with respect to echogenicity, shape, and contours showed very footling change with time. Echogenicity changed from hyperechoic to hypoechoic in only one field of study, and the previously regular contours became irregular in two subjects.

The polyps inverse from pedunculated to sessile in two of the 14 subjects and, vice versa in three cases, with polyps becoming pedunculated which had previously been sessile or impossible to appraise.

These changes may be attributed to improvements in ultrasound technology with greater resolution. Our follow-upward population is also small for u.s.a. to make more than precise statements on the relevance of these changes. Previous follow-up studies on gallbladder polyps have non recorded whatsoever data on changes in echogenicity, shape or contours with time, then that nosotros are unable to say more at the present time [two, three, 7,8,9,10,eleven,12,xiii,14,15,16,17,18,19,20].

Conclusions

In our 2022 follow-upward report, we found the prevalence of gallbladder polyps to be considerably higher than in the original 2002 report. Looking at other studies also, there has been a progressive increase in the prevalence over the years from 1990 to the nowadays. One possible reason for the increment may exist improvements in ultrasound technology. In the long term, new polyps developed in 8.seven% of our study population, existing polyps persisted in 51.9% of subjects and disappeared in 48.1%. The improved ultrasound technology seems to be the reason for the higher prevalence. Nosotros have confirmed a higher prevalence in middle-anile subjects.

Abbreviations

%:

per centum

BMI:

Body mass index

EMIL:

Echinococcus multilocularis in Leutkirch

mm:

millimetre

SAS:

Statistical analysis arrangement

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Acknowledgements

Members of the EMIL I and Two study groups in alphabetical order: Adler G, Armsen A, Banzhaf H-Thousand, Bauerdick K, Bernhardt P, Bertling U, Boehm BO, Brandner BO, Brockmann And so, Deckert G, Dingler C, Eggink S, Fuchs M, Gaus W, Goussis H, Gruener B, Gruenert A, Haenle MM, Hampl W, Haug C, Hay B, Heitz Fifty, Huetter M-Fifty, Iftikhar N, Imhof A, Kaltenbach T, Kern P, Kimmig P, Kirch A, Klass D, Koenig Due west, Kratzer W, Kron M, Manfras B, Meitinger K, Mertens T, Oehme R, Pfaff Yard, Piechotowski I, Reuter Southward, Romig T, von Schmiesing AFA, Stanosek S, Steinbach G, Tourbier G, Voegtle A, Walcher T, Wolff S, Schlingeloff P.

Funding

Non applicable.

Availability of data and materials

The datasets used and analysed during the current report are available from the corresponding author on reasonable request.

Author information

Affiliations

1. Centre for Internal Medicine, Section of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany

   Linda Heitz, Wolfgang Kratzer & Julian Schmidberger

2. Department of Diagnostic and Interventional Radiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany

   Tilmann Gräter

Consortia

for the EMIL study group

• G. Adler
• , A. Armsen
• , H-M Banzhaf
• , M. Bauerdick
• , P. Bernhardt
• , U. Bertling
• , B. O. Boehm
• , B. O. Brandner
• , Due south. O. Brockmann
• , M. Deckert
• , C. Dingler
• , Due south. Eggink
• , K. Fuchs
• , W. Gaus
• , H. Goussis
• , B. Gruener
• , A. Gruenert
• , M. One thousand. Haenle
• , Westward. Hampl
• , C. Haug
• , B. Hay
• , L. Heitz
• , One thousand-50 Huetter
• , North. Iftikhar
• , A. Imhof
• , T. Kaltenbach
• , P. Kern
• , P. Kimmig
• , A. Kirch
• , D. Klass
• , W. Koenig
• , Due west. Kratzer
• , M. Kron
• , B. Manfras
• , K. Meitinger
• , T. Mertens
• , R. Oehme
• , Grand. Pfaff
• , I. Piechotowski
• , S. Reuter
• , T. Romig
• , A. F. A. von Schmiesing
• , S. Stanosek
• , G. Steinbach
• , Thou. Tourbier
• , A. Voegtle
• , T. Walcher
• , S. Wolff
•  & P. Schlingeloff

Contributions

LH, JS and WK designed the study. LH, TG, WK and JS collected the data. The analysis was washed by WK and JS. LH, WK, TG and JS wrote the paper. All authors read and approved the concluding manuscript.

Corresponding author

Correspondence to Wolfgang Kratzer.

Ideals declarations

Ethics approval and consent to participate

The Ethics Committee of the Baden-Württemberg Medical Clan approved both the EMIL-I report in 2002 and the EMIL-II written report in 2022 (Application numbers 133/02 and 244/13, respectively). The participating patients gave their written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Heitz, L., Kratzer, W., Gräter, T. et al. Gallbladder polyps – a follow-upwardly study after 11 years. BMC Gastroenterol 19, 42 (2019). https://doi.org/10.1186/s12876-019-0959-three

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• Received: 04 July 2022

• Accustomed: 07 March 2022

• Published: xviii March 2022

• DOI : https://doi.org/10.1186/s12876-019-0959-3

Keywords

• Gallbladder polyps
• Prevalence
• Long-term progression
• Ultrasonography

Do Gallbladder Polyps Need To Be Removed,

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