title: Management and diagnosis of gallbladder polyps: a systematic review.
abstract: OBJECTIVE
  Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs.
  
  
  METHODS
  MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points.
  
  
  RESULTS
  Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy.
  
  
  CONCLUSIONS
  Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.
authors.affiliation: Leicester HPB Unit, University Hospitals of Leicester, Gwendolen Road, LE5 4PW, Leicester, UK, drbenoy@yahoo.com.
authors.forename: Benoy I
authors.initials: BI
authors.lastname: Babu
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011237:Predictive Value of Tests; D015995:Prevalence; D014057:Tomography, X-Ray Computed