JGH open : an open access journal of gastroenterology and hepatology · 2026
Differentiation of Gallbladder Adenomyomatosis and Polyps in a Western Cohort: Prevalence, Ultrasound Characteristics, and Diagnostic Challenges.
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Neumann Marie, Kallenbach Michael, Morgera Ulrike, Cariati Andrea, Morawietz Lars, Jacobsen Frank, Dubois Frank, Herberger Sebastian, Hanisch Falko, Khouja Slim, Wermke Wolfram, Dörffel Yvonne
Аннотация
BACKGROUND: Gallbladder adenomyomatosis and polyps are common benign lesions that can mimic malignancy on imaging, often leading to unnecessary cholecystectomy. Despite frequent sonographic detection, the prevalence of adenomyomatosis in living cohorts remains poorly defined.
AIM: To determine the prevalence and characterize the sonographic features of gallbladder adenomyomatosis and polyps in a large unselected cohort, and to assess clinical relevance.
METHODS: We retrospectively analyzed 2674 patients (≥ 16 years) who underwent abdominal ultrasound over 20 months. Examinations were performed by highly experienced sonographers using B-mode, color Doppler, superb microvascular imaging and contrast-enhanced ultrasound. Adenomyomatosis and polyps were classified based on morphology, wall involvement, vascularity, and Rokitansky-Aschoff sinuses (RAS). Follow-up imaging was available in 68 of 123 patients with polyps (median 76 months).
RESULTS: Adenomyomatosis was diagnosed in 32 patients (1.2%). Characteristic features included hypoechoic or isoechoic thickened wall with anechoic or microlith-filled RAS, often producing comet-tail and twinkling artifacts. Only one patient required cholecystectomy due to symptomatic diffuse disease. Gallbladder polyps were identified in 123 patients (4.6%). Most polyps remained stable or showed minimal growth, with only three patients undergoing surgery, revealing two cholesterol polyps and one precancerous intracholecystic papillary neoplasm (0.04% of the total cohort).
CONCLUSION: Structured, high-quality ultrasound enables reliable differentiation of adenomyomatosis and benign polyps from lesions suspicious for malignancy. The vast majority of findings are benign, supporting conservative management. These results provide a reference standard for sonographic assessment and emphasize the importance of awareness and systematic evaluation of gallbladder wall abnormalities.
AIM: To determine the prevalence and characterize the sonographic features of gallbladder adenomyomatosis and polyps in a large unselected cohort, and to assess clinical relevance.
METHODS: We retrospectively analyzed 2674 patients (≥ 16 years) who underwent abdominal ultrasound over 20 months. Examinations were performed by highly experienced sonographers using B-mode, color Doppler, superb microvascular imaging and contrast-enhanced ultrasound. Adenomyomatosis and polyps were classified based on morphology, wall involvement, vascularity, and Rokitansky-Aschoff sinuses (RAS). Follow-up imaging was available in 68 of 123 patients with polyps (median 76 months).
RESULTS: Adenomyomatosis was diagnosed in 32 patients (1.2%). Characteristic features included hypoechoic or isoechoic thickened wall with anechoic or microlith-filled RAS, often producing comet-tail and twinkling artifacts. Only one patient required cholecystectomy due to symptomatic diffuse disease. Gallbladder polyps were identified in 123 patients (4.6%). Most polyps remained stable or showed minimal growth, with only three patients undergoing surgery, revealing two cholesterol polyps and one precancerous intracholecystic papillary neoplasm (0.04% of the total cohort).
CONCLUSION: Structured, high-quality ultrasound enables reliable differentiation of adenomyomatosis and benign polyps from lesions suspicious for malignancy. The vast majority of findings are benign, supporting conservative management. These results provide a reference standard for sonographic assessment and emphasize the importance of awareness and systematic evaluation of gallbladder wall abnormalities.