Gallbladder Polyp · Surveillance vs Cholecystectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Size + risk factors + symptoms
   Polyp size? Risk factors? Symptoms/suspected malignancy? (Risk factors: age >50, sessile, primary sclerosing cholangitis, coexisting gallstones, rapid growth on follow-up (≥2 mm/year).)
   • ≥10 mm, or 6–9 mm + risk factors, or symptomatic (with stones) → Resection indication → laparoscopic cholecystectomy
   • 6–9 mm no risk factors → 6–9 mm → ultrasound surveillance
   • <6 mm no risk factors → <6 mm → low-frequency surveillance/observe
   • >15–18 mm / suspected malignancy (focal wall thickening, rich vascularity) → >15–18 mm/suspicious → extended resection
2. [End] Resection indication → laparoscopic cholecystectomy
   ≥10 mm, or 6–9 mm + risk factors, or symptomatic → laparoscopic cholecystectomy; send the specimen for pathology.
3. [End] 6–9 mm → ultrasound surveillance
   6–9 mm no risk factors → ultrasound surveillance (6 months, 1 year, then annually to 5 years); growth ≥2 mm or reaching 10 mm or new risk factors → resection.
4. [End] <6 mm → low-frequency surveillance/observe
   <6 mm no risk factors → low-frequency ultrasound surveillance or observation (per guideline, at 1, 3, 5 years); reassess if risk factors appear.
5. [End] >15–18 mm/suspicious → extended resection
   >15–18 mm or suspected malignancy (sessile, focal gallbladder wall thickening, rich vascularity) → treat as gallbladder cancer: extended cholecystectomy (with liver-bed wedge + regional lymph nodes), complete staging preoperatively.

Source guidelines & references

• Gallbladder polyp management (European multisociety joint guideline, 2022 update)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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