PTU-081 Treatment and surveillance of polypoid lesions of the gallbladder in the UK: result of a survey

Abstract

Introduction The management of gallbladder polyps (GBP) is still controversial. The increased use of routine abdominal imaging has led to a parallel surge of identified polypoid lesions in the gallbladder. The vast majority of these lesions are benign. True polyps, which are less frequent, have a malignant potential and surgery can prevent/treat early gallbladder cancer. In an era of constraint on health care resources it is important to offer cholecystectomy only to patients who have appropriate indications. Methods The aim of this study was to assess the treatment and surveillance policies of GBP among hepatobiliary and upper GI surgeons in UK in the light of the current published literature. A questionnaire on GBP was devised and sent to the Consultant Surgeon members of the Association of Upper GI Surgeons (AUGIS) of Great Britain and Ireland after approval from the AUGIS Committee. There were eight questions regarding indications for laparoscopic cholecystectomy (LC) and surveillance based on GBP characteristics (size, number and growth rate), and patient characteristics (age, comorbidities and ethnicity). Results There were 79 completed questionnaires. Three-quarters of surgeons consider 1cm as the size threshold for recommending surgery but 9% would consider LC irrespective of GBP size. 25% would recommend LC for multiple polyps irrespective of the size of the largest GBP. 28% of surgeons emphasise a growth rate of 5 mm or more as an indication for LC; more than 50% would not offer LC unless the polyp size matches their criteria for single polyp LC. 25% would recommend surgery for any number increase of GBP between surveillance scans. Surveillance protocols were heterogeneous but about 40% would agree to surveillance up to 5 years. About 30% would not offer LC for octagenarians and 10% would reconsider their surgery treshold according to ethnicity. Conclusion GBP are a relatively common finding on abdominal ultrasound scans. About 50 000 LC are performed each year in UK and 800–4000 are for GBP. The survey has shown considerable heterogeneity among surgeons regarding treatment and surveillance protocols. Although no randomised controlled trials exist, international guidelines would help standardisation, formulation of an appropriate algorithm and appropriate use of resources. Competing interests None declared.