Gallbladder polyps are projections from its wall, usually found incidentally on ultrasound. The vast majority are benign (cholesterol pseudopolyps). The critical parameter is size: polyps ≥10 mm, those that grow, or those causing symptoms are treated with cholecystectomy. Smaller ones are monitored.
What are gallbladder polyps?
They are projections (outgrowths) of the wall of the gallbladder into its lumen. They are not all the same: the vast majority are cholesterol pseudopolyps (cholesterol deposits, entirely benign). Next come adenomyomatosis and inflammatory polyps, while true adenomatous polyps — which are potentially neoplastic — are less common.
Because ultrasound cannot always distinguish the type with certainty, the clinical approach relies on objective risk criteria — chiefly the size and its change over time.
How common are they?
Gallbladder polyps are found in about 4–7% of adults undergoing an upper-abdominal ultrasound. With the widespread use of imaging, they are an increasingly common incidental finding.
The reassuring picture is that the vast majority are small (under 10 mm) and benign. The surgeon's role is to separate the small minority that need treatment from the majority that are simply monitored.
How do they present?
In most cases polyps are asymptomatic and are discovered incidentally. When symptoms occur, they are usually due to coexisting gallstones rather than the polyps themselves:
- Atypical or typical right-upper-quadrant pain (biliary colic), especially after a fatty meal.
- A feeling of indigestion, heaviness or bloating in the upper abdomen.
- Nausea, usually in combination with gallstones.
- More rarely, episodes of inflammation when stones coexist.
How is it diagnosed?
Diagnosis and follow-up rely mainly on ultrasound, with additional tests in selected cases:
- Upper-abdominal ultrasound — the investigation of choice for detection, sizing and follow-up.
- Endoscopic ultrasound (EUS) or contrast-enhanced ultrasound for better characterisation of equivocal polyps.
- CT or MRI for large, suspicious or broad-based polyps.
- Laboratory tests (liver biochemistry) when there is relevant suspicion.
What increases the risk?
Certain features are associated with a higher chance that a polyp is neoplastic and strengthen the indication for surgical removal:
- Size of 10 mm or larger — the most important factor.
- Growth of ≥2 mm on a repeat ultrasound.
- Age over 50–60.
- A broad-based (sessile) polyp or focal wall thickening.
- Coexisting gallstones.
- Primary sclerosing cholangitis (PSC).
Modern treatment options
Management is individualised according to size, morphology and risk factors — from simple surveillance to definitive cholecystectomy.
For details of the techniques, see the Surgical Services page and the Gallstones page.
Ultrasound Surveillance
For small polyps without risk factors. The schedule is individualised: 6–9 mm polyps are followed more closely, while those under 6 mm are followed at wider intervals. The aim is to detect any growth early.
Laparoscopic Cholecystectomy
The treatment of choice for polyps ≥10 mm, those that grow, those causing symptoms or carrying risk factors. The whole gallbladder is removed through small incisions and the specimen is sent for histological examination.
Robotic Cholecystectomy
In selected cases with difficult anatomy or equivocal findings. The robotic system offers three-dimensional vision and high precision of movement for safe dissection and removal.
Frequently asked questions
Are gallbladder polyps dangerous?
In the great majority, no. About 70% are cholesterol pseudopolyps — entirely benign. The concern is true (neoplastic) polyps, whose risk is linked mainly to size: polyps 10 mm or larger need closer attention.
When is surgery needed for a gallbladder polyp?
Cholecystectomy is advised when a polyp is 10 mm or larger, when it grows by at least 2 mm on follow-up, when it causes symptoms, or when risk factors are present (e.g. age, a broad base, gallstones, primary sclerosing cholangitis).
Does a small polyp need monitoring?
Yes, usually with repeat ultrasounds. Polyps under 6 mm are followed at wider intervals (or, without risk factors, may not need continued surveillance), while polyps of 6–9 mm are followed more closely. The schedule is individualised.
Can just the polyp be removed?
No. A polyp is not removed on its own — the whole gallbladder is removed (cholecystectomy), usually by a laparoscopic or robotic technique. The specimen is always sent for histological examination.
Can a polyp turn into cancer?
True adenomatous polyps have malignant potential, which is why size and growth matter. Gallbladder cancer overall is rare. Correct assessment and timely cholecystectomy for higher-risk polyps is precisely how it is prevented.