Natural history of small gallbladder polyps is benign: evidence from a clinical and pathogenetic study.
OBJECTIVE
Little is known about the natural history and pathogenesis of small gallbladder polyps (<10 mm, usually of the cholesterol type), particularly in Western populations. It is unclear if these polyps and gallstones represent different aspects of the same disease. The aim of this study was to characterize the natural history and pathogenesis of small gallbladder polyps.


METHODS
Fifty-six Caucasian patients with small gallbladder polyps, 30 matched gallstone patients, and 30 controls were enrolled in this 5-year prospective study. Patients underwent a symptomatic questionnaire, abdominal ultrasonography, and ultrasonographic evaluation of gallbladder motility at baseline and yearly intervals for 5 years. Cholesterol saturation index, cholesterol crystals in bile, and apolipoprotein E genotype were also determined.


RESULTS
Most patients with polyps (mean size: 5.3 mm) were men (61%), asymptomatic, and had multiple polyps (57%). Polyps did not change in 91% of patients during follow-up. No subject experienced biliary pain or underwent cholecystectomy; four developed gallstones. Cholesterol saturation index was higher in patients with polyps or gallstones than in controls (P<0.05). Cholesterol crystals were more frequent in patients with polyps than in controls (P<0.0001) but less common than in gallstone patients (P<0.0001). Polyps and gallstones were associated with nonapolipoprotein E4 phenotypes.


CONCLUSIONS
The natural history of small gallbladder polyps was benign, as no patient developed specific symptoms and/or morphological changes in polyps. Consequently, a "wait and see" policy is advisable in these patients. Polyps have some pathogenetic mechanisms in common with gallstones, but few patients developed gallstones.
Colecchia
Antonio
A
Department of Internal Medicine and Gastroenterology, University of Bologna, Italy. antonio.colecchia@aosp.bo.it
Larocca
Anna
A
Scaioli
Eleonora
E
Bacchi-Reggiani
Maria Letizia
ML
Di Biase
Anna Rita
AR
Azzaroli
Francesco
F
Gualandi
Roberta
R
Simoni
Patrizia
P
Vestito
Amanda
A
Festi
Davide
D
D000328:Adult; D001057:Apolipoproteins E / Q000032:analysis; D001646:Bile / Q000737:chemistry; D002784:Cholesterol / Q000032:analysis; D015365:Enoxacin; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D016473:Gallbladder Emptying; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology
D001057:Apolipoproteins E; D015365:Enoxacin; D002784:Cholesterol