Gallbladder polyps are usually benign tumors, which in many cases are completely symptom-free and are therefore not infrequently discovered only by chance during an ultrasound examination. Smaller polyps usually do not require therapy, but should be regularly checked sonographically. However, for findings larger than ten millimeters, (usually laparoscopic) removal of the entire gallbladder is recommended, as larger gallbladder polyps carry the rare risk of degeneration into carcinoma.
What are gallbladder polyps?
Gallbladder polyps are among the most common benign growths of the gallbladder, and because they are often asymptomatic, they are often discovered only by chance during routine ultrasound examinations. It is not uncommon for gallbladder polyps to contain cholesterol as well as mucosal cells, which can make them difficult to distinguish from gallstones in sonographic diagnostics. They usually only become medically relevant when they are about ten millimeters in size or have a rapid growth tendency. In these cases, due to the risk of (rare) degeneration of the polyps into a carcinoma, the precautionary removal of the entire gallbladder with subsequent histological examination of the tissue will be decided upon. Approximately one in twenty people – men more likely than women – will be confronted with gallbladder polyps during their lifetime.
Causes
Among the main causes of gallbladder polyps – similar to the typical gallstone – is an elevated level of cholesterol in the bile. In addition to deposits on the mucosa of the gallbladder (cholesteatosis), this also causes cholesterol-containing protrusions of the mucosa, known as cholesterol polyps. Interestingly, stones and polyps almost never form together in the same gallbladder – in most patients, only one of the two structures is ever found diagnostically. Since in both cases an excess of cholesterol leads to the formation, a defective diet must also be considered as a primary cause. Other growths in the gallbladder can also promote the formation of polyps. Usually, these are benign adenomas that develop either from the mucosa of the gallbladder or from glandular tissue (cystadenomas) and contribute to the development of gallbladder polyps.
Symptoms, complaints, and signs
Gallbladder polyps often remain asymptomatic or cause symptoms similar to gallstones. They are benign growths on the gallbladder, but in rare cases they sometimes degenerate into malignancy. It has been observed that people suffering from gallstones do not develop biliary polyps. Conversely, patients with gallbladder polyps do not develop gallstones regardless of whether they have no symptoms or are symptomatic. Whether gallbladder polyps cause symptoms depends on the size of the polyps and the stage of development of the disease. Isolated gallbladder polyps often show no symptoms. However, if they occur in conjunction with other diseases, nausea, vomiting, pain in the right upper abdomen with radiation to the shoulder girdle, bloating, flatulence and colic may occur. These are complaints that can occur in a similar way with gallstones. Extensive polyp formation can also block bile ducts and vascular supply. Obstruction of the bile duct leads to jaundice, which is manifested by yellowing of the skin and eyes. Furthermore, there is excruciating itching and fatigue. Liver function can be so impaired that its detoxification function fails. Toxic metabolic products then accumulate in the body. After removal of the affected gallbladder, the symptoms usually disappear completely. At the same time, this also eliminates the risk of gallbladder polyps degenerating into gallbladder cancer.
Diagnosis and course
Diagnosis of gallbladder polyps is made by sonography, although the difference between cholesterol-containing polyps and gallstones is not always clear on ultrasound because of their similar appearance. It is also possible to overlook gallbladder polyps – on the one hand, if they are still very small, and on the other hand, because they often cannot be sufficiently delineated from the surrounding tissue structures. Some laboratory values (gamma-GT, alkaline phosphatase) can also confirm the suspicion that something is happening in the gallbladder.Often, people affected by gallbladder polyps remain completely pain-free, but symptoms such as pain in the right upper abdomen, which can move into the shoulder, nausea and digestive problems are possible, especially in combination with other biliary disorders. In combination with other disorders (stone, tumor), polyps can cause jaundice via congestion of the bile flow. In addition, with larger gallbladder polyps, the risk – although rather rare – of degeneration into carcinoma must always be considered.
Complications
As a rule, gallbladder polyps themselves do not cause discomfort, pain, or complications. For this reason, polyps also remain undetected for a very long time and are diagnosed only by chance in most cases. However, they can cause pain or nausea in connection with other gallbladder diseases. It is not uncommon to also experience digestive discomfort or diarrhea. In some cases, jaundice occurs. For this reason, treatment does not take place in every case. If the gallbladder polyps are relatively small and do not cause discomfort or pain, they are usually not removed. In this case, there are no further complications for the patient and the polyps do not lead to consequential damage. However, if the gallbladder polyps are large and spread and grow, the entire gallbladder must be removed in most cases. The affected person suffers a relatively heavy weight loss and complains about a general feeling of illness. There is also an increased risk of cancer in the patient. Furthermore, however, no particular complications occur.
When should one go to the doctor?
Gallbladder polyps often go unnoticed by the patient because they are often asymptomatic. In most cases, they are only noticed during a control examination by ultrasound. Therefore, it is generally recommended to have a check-up with a primary care physician at regular intervals. Routine check-ups help with early detection and should be used by people of all ages. In addition, a doctor should be consulted as soon as any discomfort near the abdominal region occurs. If pain or discomfort sets in repeatedly, it is advisable to have these indications clarified by a doctor. If nausea, vomiting or a feeling of pressure in the chest occurs, a doctor should be consulted. If there is reduced performance, an increased need for sleep or fatigue despite sufficient night sleep, these observations should be discussed with a physician. In the case of changes in digestion, a visit to the doctor is necessary as soon as the complaints persist over several days or increase in intensity. Repeated diarrhea, constipation or intestinal obstruction are cause for concern and should be medically clarified. Medical help can also be sought if the affected person has a diffuse feeling of illness or experiences inner restlessness. If a feeling of tightness develops in the chest or if there are unusual changes in weight, consultation with a physician should be sought.
Treatment and therapy
Gallbladder polyps that are small and asymptomatic can be left in the gallbladder without further therapy, assuming regular sonographic monitoring. In cases of rapid growth and generally from an extent of about ten millimeters, the gallbladder should be removed completely by surgery (cholecystectomy). In uncomplicated cases, this is usually done very gently during a laparoscopy. For the patient, who does not suffer any major restrictions as a result of the loss of the gallbladder, neither the operation nor the time after the operation is usually a difficult burden. In the case of symptoms such as frequent indigestion, chronic fatigue or unwanted weight loss, degeneration into a precancerous condition or carcinoma must also be considered, despite its relatively rare occurrence. If advanced disease is suspected, surgery can also be performed with the aid of an abdominal incision (laparotomy), as this additionally provides the physician with a good intraoperative exploration of the abdominal cavity and thus the extent of the disease that has developed at the base of a gallbladder polyp.
Outlook and prognosis
The prognosis for gallbladder polyps depends on the stage of the disease and the size of the polyps present. Generally, a gallbladder polyp is benign and receives a good prognosis.The tissue changes can be completely removed in a routine procedure. Following wound healing, the patient is discharged from treatment as symptom-free. The larger the gallbladder polyps that have developed, the more likely it is that the disease will become malignant. This worsens the prognosis for the patient immensely. If left untreated, there is a risk of a steady increase in symptoms and a continuous deterioration in general health. In addition, there is a risk that the patient will die prematurely. Cancer cells develop and can spread in the organism to form metastases in other places. Early diagnosis and treatment is therefore crucial for the further course of gallbladder polyps. Although there is normally a rapid recovery when the tissue changes are removed, the patient can be exposed to a new development of polyps at any time. In the course of life, a new outbreak of the disease is possible with the same prognosis. If the gallbladder polyps are in hard-to-reach locations, the likelihood of complications during the procedure is possible. Damage to surrounding tissues may occur, leading to delayed healing or impairment.
Prevention
No specific form of prophylaxis is known for gallbladder polyps. However, as with gallstones, some polyps contain cholesterol, so a conscious and healthy diet can have a positive effect, at least by reducing the amount of cholesterol in the bile. There is an important method of prevention with regard to the possible degeneration of gallbladder polyps into carcinomas: if small polyps have already been diagnosed, they should be checked regularly. From a size of about ten millimeters, gallbladder polyps including the bile should be removed prophylactically.
What you can do yourself
In everyday life, patients should take care to permanently lower their cholesterol levels through their food intake. For this, a change in diet is important. The consumption of animal fats should be reduced or avoided. On the other hand, foods such as tomatoes, nuts, whole grain products, garlic, onions or leeks are helpful. These should be used more in the preparation of meals. The consumption of fruits and vegetables should be increased overall. In addition, foods containing soy or tofu support the health of the affected person. In terms of fluid intake, excessive consumption of coffee should be avoided. Mineral water or green tea help to alleviate the symptoms. Products such as butter, cream, meat, eel, smoked fish, rapeseed or olive oil increase cholesterol levels. They should be eliminated from the diet or greatly reduced. In addition to dietary changes, the patient can take some measures to stimulate the metabolism. Sufficient exercise, regular sports activities and the avoidance of nicotine or alcohol promote health and support the course of recovery. If symptoms such as nausea or dizziness occur, the patient should take it easy and allow himself sufficient rest. Overexertion should be avoided. The needs and possibilities of the organism should be taken into account in all activities so that there is no deterioration of health.