Have you ever gone in for a routine checkup or imaging appointment, only to be told that you have gallstones or gallbladder polyps? This is not uncommon. Gallstones and gallbladder polyps that form within the gallbladder are both common incidental findings. In many cases, these abnormalities occur due to the buildup of benign cholesterol cyrstals or bile pigments. As both gallstones and gallbladder polyps can lead to clinical symptoms and complications It is still essential to understand how to manage them and to know when to seek treatment if necessary.
The gallbladder is a small, pear-shaped organ located beneath the liver. It plays a vital role in storing and releasing bile, a liquid produced by the liver to aid in fat digestion. Bile is primarily composed of cholesterol, bilirubin, and bile salts.- The gallbladder acts like a storage site of excess bile that is released into the intestines for digestion of food.
In some patients, the gallbladder does not function properly and the bile does not empty well. The bile pigments and cholesterol may often get concentrated into crystals which may build up over years to form one or many stones ( cholelithiasis) within the gallbladder. Most of the time, gallstones are found incidentally when patients go in for Many individuals may go on to form gallstones without ever knowing they have them. existing gallstones will continue to grow as they are continually exposed to the presence of bile that will build on top of the hardened deposits.
Therefore, with gallstones, they may become a source of concern when they grow big enough to obstruct bile flow or travel up the biliary tract (network of liver-based organs and ducts) and cause a blockage. In such instances, patients may require treatment to manage their conditions.
Gallstones tend to form when there is an imbalance in the chemicals present in bile, such as cholesterol or other salts. This imbalance, whether in excess or lack thereof, can then trigger a crystallisation process that forms gallstones.
Gallstones may either be asymptomatic or can cause a myriad of symptoms and complications such as :
Unlike gallstones, gallbladder polyps are growths that appear on the inner lining of the gallbladder. Therefore, these growths are not free-floating but attached to the gallbladder. Gallbladder polyps are benign growths initially, but if they increase in size during follow-up or grow rapidly, they may develop into gallbladder cancer which has a very poor prognosis.
There are different types of gallbladder polyps, including benign and malignant polyps:
| Benign Tendency | Malignant Tendency |
| 1. Pseudopolyps: Also known as cholesterol polyps, often occur due to the buildup of extra cholesterol that sticks to the gallbladder wall. 2. Inflammatory polyps: These occur due to the presence of chronic inflammation in the gallbladder wall (cholecystitis). 3. Adenomyomatosis: An abnormal formation of cysts on the gallbladder lining. | 1. Adenomas (True Polyps): These are benign glandular tumours, but possess 0.5% risk for malignancy (pre-cancerous). 2. Adenocarcinoma: The most common type of malignant polyps, these are cancerous growths that develop from the gallbladder wall. |
Gallbladder polyps in general do not cause any particular symptoms. They are mainly incidental findings on imaging studies such as ultrasound or CT scans. Hence, most patients are unaware of existing polyps. In rare cases, gallbladder polyps growing near the neck of the gallbladder may obstruct the flow of bile out of the gallbladder, leading to obstruction and cholecystitis (inflammation of the gallbladder).
Gallstones vs Gallbladder Polyps: Key Differences
In terms of gallstone treatment, the most common form of treatment involves surgical removal using key-hole surgery ( laparoscopic cholecystectomy). This surgery has a very rapid recovery to normal and requires only a short hospitalisation. However, not all gallstones require such treatment from the get-go.
When gallstones are an incidental finding and not causing any abdominal symptoms, the patients have an option to observe and avoid surgery. However, all patients with gallstones are always warned about the potential risks and complications that can arise from gallstones and to watch for these symptoms and signs. Emergency treatment of gallstone complications has higher riss and the surgery is also more complex.
Once a gallstone starts to cause symptoms then surgical removal via key-hole laparoscopic surgery is required. If patients have had a complication from gallstones like pancreatitis or juandice from obstruction of the bile ducts, then the specialsit will also recommend removal of the gallbladder to prevent future similar life threatneing complications from recurring.
Treatment Options for Gallstones
Today, surgical removal of gallstones is still the standard of care for gallstone treatment. The reason for doing so is to prevent the recurrence of gallstones, which is highly likely if only the gallstones are removed.
By principle, polyps cannot disappear on their own. However, for those that do not cause discomfort to patients or are small in size, regular monitoring with ultrasound of the gallbladder is sufficient before further action is required. In cases where a patient is observed to have rapidly growing polyps or a large polyp > 1 cm (sign of cancer risk), removal of the gallbladder may be indicated. As a rule of thumb, specialists will refer to the following flowchart when determining whether immediate action is necessary to manage gallbladder polyps.
Polyps that are small in size (< 1 cm) and asymptomatic can generally be managed through routine observation by a specialist. During the monitoring phase via an ultrasound test, the size of the polyps will be continuously observed to ensure they do not rapidly increase in size (a potential sign of malignancy) or cause new symptoms and/or complications. Beyond a certain threshold, your specialist may determine if intervention is necessary.
As highlighted, polyps that are deemed to (potentially) impact a patient's quality of life, an intervention is likely recommended. To date, there is no available solution to manage gallbladder polyps other than surgical removal. That said, removal of the gall bladder is unlikely to cause a significant impact on the patient and they will be able to maintain a good quality of life. Today, a minimally invasive option is available for gallbladder removal to help patients with better and quicker recovery.
Gallstones and gallbladder polyps can occur together and they are often detected at the same time incidentally during an ultrasound. In most cases, a surgery is likely recommended as the presence of gallstones can increase the cancer risk of gallbladder polyps.
Experiencing persistent symptoms like post-meal abdominal pain, discomfort, bloating or nausea can understandably be confusing, as it could be due to a multitude of underlying conditions. Under such circumstances, a patient should see a specialist to get advice and recommendations.
For gallstone treatment and gallbladder polyp management, patients often need to consult a General Surgeon who is trained and experienced in minimally invasive laparoscopic surgery. oIn Singapore, you can visit ACE Specialist Surgery and Endoscopy Centre, helmed by Senior ConsultantGeneral Surgeon, Dr Reyaz Singaporewalla. He has more than 2 decades of experience in successful management of both simple and complex gallbladder surgeries.
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