Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Issue 5 (October 2016)

• Record Type: Journal Article
• Authors: Bhatt, Nikita R.; Gillis, Amy; Smoothey, Craig O.; Awan, Faisal N.; Ridgway, Paul F.
• Is Part Of: Surgeon. Volume 14:Issue 5(2016)
• Page Start: 278
• Page End: 286
• Publication Date: 2016-10
• Subjects: Gallbladder -- Polyp(s) -- Systematic review -- Malignant -- Size; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2015.12.001
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Background: There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. Aim: To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management. Methods: A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy. Results: Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm–10 mm, a risk assessment model was formulated. Conclusions: This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.