163 Gallbladder Polyp Screening: Are We Over-Scanning and Over-Operating?

Abstract Introduction Gallbladder polyps, mucosal projections into the gallbladder lumen, have a reported prevalence of 4–7%. Current guidelines recommend cholecystectomy for polyps >10 mm or smaller polyps with specific risk factors (e.g. age >50, primary sclerosing cholangitis, sessile morphology, or focal wall thickening >4 mm). Surveillance and surgical intervention are resource-intensive and not without risk. Method A retrospective analysis was conducted on all cholecystectomies performed at a district general hospital between January 2021 and December 2024. Imaging findings were compared with histological results. All gallbladders were sent for histology as part of a normal routine. For cases where polyps were the indication for surgery, the number, size, and associated patient risk factors were reviewed. Results Of 806 cholecystectomies, 41 (5.1%) were performed due to gallbladder polyps detected on imaging. Histologically confirmed polyps were found in 15 cases (37%), along with one case of adenocarcinoma. The mean size of the largest polyp reported on imaging was 7.5mm (range 2.8–15mm). Multiple polyps on imaging were significantly more likely to correlate with histological confirmation than solitary polyps (p = 0.003), but the size of the polyp on imaging was not (p = 0.542). Conclusions This study demonstrates a low concordance between pre-operative imaging and histological confirmation of gallbladder polyps. These findings raise concerns about the potential overuse of imaging and surgery. Refinement of risk stratification criteria may help reduce unnecessary interventions while maintaining vigilance for malignancy.