I have encountered a lot of seafarers seeking surgical clearance for gallbladder polyps and cholesteroloses seen on ultrasound.
This is what I usually do.
I give them a clearance to travel and work as seafarer if there is no history of jaundice; no history of symptoms suggestive of a gallbladder disease; no jaundice and no palpable abdominal mass and tenderness at the right upper quadrant; and the polyps / cholesteroloses are less than 1 cm.
Ultrasound reports that I usually see are “gallbladder polyp/s,” “gallbladder cholesterolosis / cholesteroloses”, and gallbladder polyps and / or cholesteroloses.”
Ultrasonographers usually commit to cholesteroloses if the polypoid structure protruding from the lining of the gallbladder has a distinctively round configuration. Otherwise, they just mention “polyps.”
Gallbladder polyp is a generic term that connotes a growth that protrude from the lining of the inside of the gallbladder. See illustrations below.
Gallbladder polyps can be benign or malignant (cancer). Majority are benign as high as 95%. Majority of the benign polyps are cholesterol polyps (more than 50%). Other benign polyps are inflammatory polyps, adenomatous polyps, and other types. Majority of the benign polyps are non-neoplastic (non-newgrowth). Examples of non-neoplastic polyps are the cholesterol and inflammatory polyps.
Gallbladder cancer in gallbladder polyps are rare (less than 5%). In the United States, the incidence is 1.2 / 100,000 persons. In the Philippines, there are no statistics but the incidence is considered rare.
The size of a gallbladder polyp can help predict whether it’s cancerous (malignant) or noncancerous (benign). Small gallbladder polyps that are less than about 10 mm in diameter are unlikely to be cancerous and generally don’t require treatment. Wait and watch or watch and wait is advised with follow-up examinations using ultrasound at planned intervals.
Gallbladder polyps larger than 10 mm in diameter are more likely to be cancerous and those larger than about 15 mm in diameter may pose a significant risk of being malignant.
For the gallbladder polyps with such sizes, surgical removal of the gallbladder with the polyp (cholecystectomy) is usually advised.
How to avoid development and further progression of gallbladder polyps? There are no sure ways of prevention as the specific causes of the gallbladder polyps are unknown. For gallbladder cholesterol polyps, a problem in cholesterol metabolism is hypothesized. The exact mechanism of causation is unknown though. For the moment, best effort is to limit fatty food intake at least and hope for a good outcome. Another advice is to limit, if not avoid, alcohol intake.
Once a gallbladder polyp is present, it is usually permanent. It may decrease in size to the point that it cannot be detected by ultrasound. Best efforts with no guarantee in preventing progression in term of number and size are to limit fatty food and alcohol intake.
Note 1: Gallbladder polyps are not the same as gallbladder stones. Stones are hardened deposits or concretions of bile duct components within the lumen of the gallbladder, not outgrowth from the inner lining of the gallbladder which are the polyps.
Note 2: For gallbladder polyps less than 10 mm, asymptomatic, treatment is just wait and watch.
Note 3: For gallbladder polyps less than 10 mm, asymptomatic, best effort, no guarantee though, to prevent progression is to limit fatty food intake and alcohol.