Gallbladder Polyps

What are Gallbladder Polyps?

Gallbladder polyps are growths that protrude from the gallbladder lining, a small organ beneath the liver. These polyps can be singular or multiple and vary widely, typically ranging from a few millimetres to more than a centimetre in diameter. Most gallbladder polyps in Singapore are benign, meaning they are non-cancerous and do not pose a significant health risk. However, a small percentage may be precancerous or cancerous, especially those larger than 1 cm in size.

There are five possible scenarios if gallbladder polyps are seen on imaging, these are:

• Pseudopolyps: pseudopolyps, also known as cholesterol polyps, occur due to cholesterolosis, a benign condition in which an excess cholesterol deposit sticks to the side of the gallbladder and forms polyps.
• Inflammatory polyps: inflammatory polyps are linked to chronic cholecystitis, which causes scar tissue on the gallbladder walls.
• Adenomyomatosis: adenomyomatosis is characterised by the growth of cysts on the gallbladder walls. 
• Adenomas: adenomas are benign tumours that typically begin in the epithelial cells of the gallbladder. Larger adenomas may transform malignantly. 
• Malignant polyps: malignant polyps are typically adenocarcinoma, such as those seen in gallbladder cancer. 

What causes Gallbladder Polyps?

Abnormal cell growth: in some cases, an abnormal proliferation of cells in the gallbladder wall can lead to polyp development. This is more concerning if the growth is uncontrolled, as it might indicate a precancerous or cancerous condition.

What are the symptoms of Gallbladder Polyps?

Gallbladder polyps are often asymptomatic, meaning they do not cause symptoms. Many people with polyps are unaware they have them until they are discovered by chance during health screening or imaging tests for other abdominal complaints.

When symptoms of gallbladder polyps occur, they may include:

• Bloating: a feeling of fullness or bloating, especially after eating fatty foods, can occur due to the gallbladder's impaired ability to release bile.
• Nausea or vomiting: similar to gallstones, polyps can cause nausea or vomiting, particularly after eating.
• Pain: pain in the right upper quadrant of the abdomen is possible if a polyp grows large enough to cause blockage or irritation within the gallbladder.

Generally, the presence of symptoms does not necessarily indicate a serious problem; however, larger polyps that cause symptoms may require more attention due to their potential to harbour malignant cells.

Are Gallbladder Polyps painful?

Gallbladder polyps themselves are usually not painful. The majority of individuals with gallbladder polyps do not experience any symptoms, including pain. However, if a polyp grows large enough to obstruct the outflow of the gallbladder, it can lead to discomfort or pain. This pain is typically located in the upper right side of the abdomen and may radiate towards the back or right shoulder. Pain associated with gallbladder issues, including polyps, often follows the consumption of fatty meals, which stimulates the gallbladder to release bile.

Who is at risk of Gallbladder Polyps in Singapore?

Gallbladder polyps can affect anyone, but certain factors may influence the risk within the Singapore population:

• Age: males over the age of 40 and females over the age of 50 are more at risk of developing gallbladder polyps.
• Gender: men are slightly more likely than women to develop gallbladder polyps.
• Obesity and diabetes: metabolic syndromes such as diabetes and obesity can increase the risk of gallbladder problems, including polyps.

How are Gallbladder Polyps diagnosed?

Diagnosis of gallbladder polyps often occurs incidentally during imaging tests for other conditions. The primary diagnostic tool for gallbladder polyps is:

• Ultrasound: an abdominal ultrasound is the most common and effective method for identifying gallbladder polyps. It can help determine the size and number of polyps, which are substantial factors in deciding the management approach.

In some cases, further imaging tests may be required to get a more detailed view or if there is a suspicion of cancer:

• Magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP): an MRI or MRCP offers detailed images of the bile ducts, gallbladder, and liver, which may help distinguish polyps from stones or other conditions.

What are the treatment options for Gallbladder Polyps in Singapore?

The treatment for gallbladder polyps in Singapore depends on the size of the polyps, the presence of symptoms, and whether there is a suspicion of cancer:

• Observation: small, asymptomatic polyps (less than 1 cm) without suspicious features are usually monitored with periodic ultrasound exams to check for changes in size or number.
• Cholecystectomy: a cholecystectomy, the removal of the gallbladder, is recommended for symptomatic polyps, polyps larger than 1 cm, or if there is any concern they could be cancerous. In Singapore, laparoscopic cholecystectomy is the preferred method due to its minimally invasive nature, resulting in shorter recovery times and less post-operative discomfort.

Frequently asked questions

Can gallbladder polyps lead to gallbladder cancer?

Yes, large polyps may cause malignant transformation, especially those > 1cm. Hence, surgery is recommended in such cases.