What are the guideline sources, guidelines and references for Gallbladder polyps ?
Guideline sources The following summarized guidelines for the evaluation and management of gallbladder polyps are prepared by our editorial team based on guidelines from the American Association for the Study of Liver Diseases (AASLD 2022), the European Society of Gastrointestinal Endoscopy (ESGE/EFISDS/EAES/ESGAR 2022), the European Association for the Study of the Liver (EASL 2022; 2016), the British Society of Gastroenterology (BSG 2019), the American College of Gastroenterology (ACG 2015), and the American Society for Gastrointestinal Endoscopy (ASGE 2013). 1 2 3 4 5 6 7 Calculator CholeS score for duration of lap Guidelines 1. Classification and risk stratification https://web.pathway.md/diseases/rec6gB551elGYX49Q 1/4 6/24/23, 2:54 AM Gallbladder polyps Pathway Risk of malignancy: consider obtaining multidisciplinary discussion to assess the perceived individual risk of malignancy in patients with polypoid lesions of the gallbladder measuring 10 mm. B 2. Diagnostic investigations Diagnostic imaging: Obtain abdominal ultrasound for primary evaluation of polypoid lesions of the gallbladder. B Consider obtaining alternative imaging modalities (such as contrast-enhanced and EUS) to aid decision-making in difficult cases in centers with appropriate expertise and resources. B 3. Surgical interventions Indications for cholecystectomy, polyps >= 10 mm: As per ESGE/EFISDS/EAES/ESGAR 2022 guidelines, perform cholecystectomy in surgically fit patients with polypoid lesions of the gallbladder measuring 10 mm. B As per EASL 2016 guidelines, perform cholecystectomy in patients with gallbladder polyps 10 mm, without or with gallstones, regardless of symptoms. B As per ASGE 2013 guidelines, consider performing cholecystectomy in asymptomatic patients with gallbladder polyps > 10 mm. C Indications for cholecystectomy, polyps 6-9 mm: As per ESGE/EFISDS/EAES/ESGAR 2022 guidelines, perform cholecystectomy in surgically fit patients with 6-9 mm polypoid lesions of the gallbladder and 1 of the following risk factors for malignancy: age > 60 years history of PSC asian ethnicity sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). B As per EASL 2016 guidelines, consider performing cholecystectomy in patients with asymptomatic gallbladder stones and gallbladder polyps 6-10 mm. C Indications for cholecystectomy (polyps <= 5 mm): do not perform cholecystectomy in patients with asymptomatic gallbladder stones and gallbladder polyps 5 mm. D Indications for cholecystectomy, symptomatic polyps: As per ESGE/EFISDS/EAES/ESGAR 2022 guidelines, consider performing cholecystectomy in surgically fit patients with polypoid lesions of the gallbladder with symptoms potentially attributable to the gallbladder and no demonstrated alternative cause explaining symptoms. Counsel patients about the benefit of cholecystectomy versus the risk of persistent symptoms. B https://web.pathway.md/diseases/rec6gB551elGYX49Q 2/4 6/24/23, 2:54 AM Gallbladder polyps Pathway As per ASGE 2013 guidelines, perform cholecystectomy in symptomatic patients with gallbladder polyps. B Indications for cholecystectomy, growing polyps: As per ESGE/EFISDS/EAES/ESGAR 2022 guidelines, perform cholecystectomy in patients with a polypoid lesion of the gallbladder reaching 10 mm in size during follow-up. Take into consideration the current size of the polypoid lesion along with patient risk factors if the polypoid lesion grows by 2 mm within the 2-year follow-up period. Consider obtaining a multidisciplinary discussion to decide on the continuation of monitoring versus cholecystectomy. B As per EASL 2016 guidelines, consider performing cholecystectomy in patients with growing polyps. C 4. Specific circumstances Patients with primary sclerosing cholangitis, monitoring: As per AASLD 2022 guidelines, consider obtaining ultrasound surveillance every 6 months in patients with PSC and gallbladder polyps 8 mm. E As per BSG 2019 guidelines, consider obtaining an annual ultrasound of the gallbladder in patients with PSC. Direct management by a specialist hepatopancreaticobiliary multidisciplinary team if polyps are identified. C Patients with primary sclerosing cholangitis, cholecystectomy: As per AASLD 2022 guidelines, consider performing cholecystectomy in patients with advanced PSC with gallbladder polyps > 8 mm, preferably at an experienced center. E As per EASL 2022 guidelines, perform cholecystectomy in patients with PSC with gallbladder polyps 8 mm in size and smaller polyps growing in size due to the high risk of malignancy or dysplasia. B As per EASL 2016 guidelines, consider performing cholecystectomy in asymptomatic patients with PSC and gallbladder polyps, irrespective of size. C As per ACG 2015 guidelines, perform cholecystectomy in patients with PSC and gallbladder polyps > 8 mm to prevent the development of gallbladder adenocarcinoma. B As per ASGE 2013 guidelines, perform cholecystectomy in patients with PSC in the presence of any gallbladder polyps. B 5. Follow-up and surveillance Serial imaging assessment: As per ESGAR 2022 guidelines, do not obtain follow-up in patients with a gallbladder polypoid lesion of 5 mm and no risk factors for malignancy. D Show 2 more https://web.pathway.md/diseases/rec6gB551elGYX49Q 3/4 6/24/23, 2:54 AM Gallbladder polyps Pathway As per ASGE 2013 guidelines, consider obtaining serial abdominal ultrasound every 12 months in asymptomatic patients with gallbladder polyps 6-10 mm and no other risk factors for gallbladder cancer. C References 1. Christopher L Bowlus, Lionel Arriv , Annika Bergquist et al. AASLD Practice Guidance on Primary Sclerosing Cholangitis and Cholangiocarcinoma. Hepatology. 2022 Sep 9. Open 2. EASL. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65 1 146 181. Open 3. Chapman MH, Thorburn D, Hirschfield GM et al. British Society of Gastroenterology and UK PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut. 2019 Aug;68 8 1356 1378. Open 4. Anderson MA, Appalaneni V, Ben-Menachem T et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc. 2013 Feb;77 2 167 74. Open 5. Kieran G Foley, Max J Lahaye, Ruedi F Thoeni et al. Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol. 2022 May;32 5 3358 3368. Open 6. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on Sclerosing Cholangitis. J Hepatol. 2022 May 31;S0168 8278 22 00326 9. Open 7. Lindor KD, Kowdley KV, Harrison ME. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am J Gastroenterol. 2015 May;110 5 646 59. Open https://web.pathway.md/diseases/rec6gB551elGYX49Q 4/4