Real-World Management and Economic Burden of Gallbladder Polyps.

BACKGROUND

Gallbladder polyps (GBP) are found incidentally on imaging in ∼5% of the general population. Most are asymptomatic and only a very small percentage are malignant. This study examines real-world clinical practice management of GBP and adherence to the updated joint European guidelines.

METHODS

Patients with GBP between January 2019 and October 2022 were included. Clinical, radiologic, and surgical data were collected retrospectively.

RESULTS

One hundred thirty-eight patients were included (mean age 47.0±14.1; female 46.4%). The average follow-up period was 30.6±40.8 months. During the study period, only 26.0% of patients had an increase in GBP size. There were no predictors for GBP growth. Cholecystectomy was performed in 30 patients: 19 (63.3%) had GBP as the indication, and in those, only 9/19 (47.4%) had proper indications according to guidelines. No malignant polyps were found, and no GBP-related deaths were reported. Increased polyp size ( P <0.0001) and number ( P =0.014) during follow-up were significantly associated with cholecystectomy. Of the 104 patients who did not have surgery, 70 (67.3%) had no indication for follow-up imaging, but 42 (60%) were advised to continue follow-up. The average increased cost of guideline-inconsistent follow-up imaging was >$51,000 and >$67,000 for unindicated cholecystectomies, bringing total waste expenditures to >$118,000.

CONCLUSION

The natural history of GBP does not justify close or prolonged follow-up, especially in young individuals without risk factors. Poor adherence to guidelines by radiologists, gastroenterologists, surgeons, and other health care providers should be addressed, offering a real opportunity for medical education and significant health care savings.