Gallbladder 05/31/2013
Dear readers, today we will talk about polyps in gallbladder. All articles in this section are written by a doctor with extensive experience, Evgeniy Snegir, author of the website Medicine for the Soul http://sebulfin.com I give the floor to him.
When conducting an ultrasound examination, one of the unexpected findings may be polyps in the gallbladder. Typically, the situation for common man looks quite strange: nothing particularly bothers you and suddenly there are some polyps... “In general, are polyps scary? Can they get through on their own? Do I need to have surgery? - absolutely normal questions that arise from absolutely normal person, who was taken aback by such news. Let's try to figure everything out in order.
So let's start with the definition. Gallbladder polyps are benign growths of the mucosal epithelium into the lumen of the gallbladder. All clear. The mucous membrane has grown too much and a benign formation has formed. Benign means that this formation has no signs of a malignant tumor. Now fine.
Polyps in the gallbladder. Causes of occurrence.
What could be the reasons for the formation of polyps? There are several reasons.
- Burdened heredity. If your closest relatives have been diagnosed with polyps, then your risk of developing polyps is quite high.
- Errors in diet leading to disruption of cholesterol and lipid metabolism.
- Chronic inflammation of the gallbladder mucosa (chronic cholecystitis), accompanied by stagnation of bile.
- Hepatitis.
- Biliary dyskinesia.
Polyps in the gallbladder. Kinds.
Now let's look at what types of polyps there are in the gallbladder.
According to the histological picture, the following types of polyps are distinguished:
- cholesterol polyp: growth of the gallbladder mucosa with cholesterol deposition, most common.
- inflammatory polyp: proliferation of granulation tissue;
- adenoma: benign tumor of glandular tissue;
- papilloma: a benign tumor in the form of papillary growths on the mucosa.
Polyps in the gallbladder. Symptoms
As we have already emphasized, asymptomatic carriage of polyps is the most common. In this case, sometimes there is slight discomfort in the upper abdomen or right hypochondrium after taking a large dose of fatty foods.
A pronounced clinical picture can develop if the polyp has formed in the neck of the gallbladder, which is its narrowest part. In this case, periodic intense pain will appear in the right hypochondrium.
If the size of the polyp is large enough, it can even lead to blockage of the cystic duct. As a result, the gallbladder overflows, and, consequently, the pain syndrome will increase. Attachment of infection to in this case may lead to empyema of the gallbladder. In addition, bile will stop flowing into the intestines, which will lead to changes in the color of stool and urine.
Diagnosis of gallbladder polyps.
Gallbladder polyps are detected when. As we have already said, in asymptomatic cases this is usually an accidental finding. During the examination, the doctor sees a round formation that is intimately connected to the wall of the gallbladder and does not give an acoustic shadow.
Currently, another examination method is considered promising – endoscopic ultrasonography. With this method, using the principle of FGDS, a flexible endoscope with an ultrasound sensor at the end is inserted into the duodenum. The duodenum is close to the gallbladder, so the ultrasound image is much clearer and more representative.
Polyps in the gallbladder. What to do? Treatment.
The problem with gall bladder polyps is increased risk their malignancy - degeneration into malignant tumor. This is especially true for adenoma and papilloma. The risk of malignancy of polyps is quite high, it can reach 30%. Just think about these numbers. Every third of those who are “suddenly and unexpectedly” diagnosed with a polyp has a chance of getting a malignant tumor. This is how the story turns out.
That is why, if polyps are accidentally discovered in the gallbladder, when nothing seems to be bothering you, surgeons immediately suggest removing the gallbladder in a gentle way - laparoscopic cholecystectomy.
The only effective treatment for polyps in the gallbladder is surgery. No folk remedies can help the body get rid of pathological growth of the mucous membrane. Slow down - maybe. Only, in order to prove this to all thoughtful doctors, it is necessary to conduct a large multicenter study confirming that by taking, say, birch buds, it was possible to stop the growth of the polyp. As long as the patient drinks a decoction of tasty birch buds, the polyp will continue to grow. No one explained to him that his owner was taking a miracle medicine, which should definitely stop his growth, so it was better not to resist and surrender in peace. On the contrary, it will continue to persistently grow and will gradually go beyond all reasonable “frames of decency.”
And reasonable “frameworks of decency are as follows.” If it is determined that the size of the polyp is less than 5 mm, then we most likely have a deposit of cholesterol on the mucous membrane of the gallbladder, which can soon “format” into a cholesterol stone (you can read about the types of stones in the gallbladder in the article.
The size of polyps from 5 to 9 mm most likely tells us that we have a gallbladder adenoma, which, as we already understand, can become malignant. In this case, constant monitoring of polyp growth is necessary. If the polyp has a leg, then a control ultrasound should be done once every 6 months for 2 years. Then control is carried out once a year throughout life. If it turns out that the polyp has begun to grow, then the method of choice is removal of the gallbladder.
If the polyp is broad-based (does not have a stalk), then ultrasound monitoring is carried out once every three months for 2 years (such polyps are most susceptible to malignancy). Then – once a year for life. If polyp growth is noted, cholecystectomy is performed.
Polyps larger than 1 centimeter in size are a cause for serious concern. This, one might say, is an absolute indication for removal of the gallbladder. It is no longer possible to wait long for anything here. The risk of malignancy of such a polyp is directly proportional to its growth.
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Polyps in the gallbladder. Operation.
Surgical treatment is carried out in a gentle way - laparoscopic cholecystectomy is performed (you can read about the features of the operation in the article. In the preoperative period, it is necessary to undergo a comprehensive examination: perform necessary tests blood, urine, take an ECG, and, if necessary, an X-ray of the lungs, obtain a physician’s opinion on the presence of concomitant diseases and the body’s readiness for surgical intervention.
Polyp is a benign growth of the mucous membrane of hollow organs (intestines, gall and Bladder). In most cases, the formation is spherical in shape and attached to the wall with a long stem.
Polyps in the gallbladder can be of several types:
- cholesterol polyps. With this type, the mucous membrane of the bladder changes against the background of cholesterol accumulations and deposits;
- inflammatory polyps. Acute reaction of the organ lining to an increase in granulation tissue;
- bladder adenoma. Benign neoplasm against the background of growth of glandular tissue;
- papillomas. A benign tumor manifested by papillae on the mucous membrane.
But the most common type of polyp is the first one: cholesterol.
Adenoma and papilloma, despite their external benignity, can degenerate into malignant formations.
Clinical picture
The complexity of the disease is that symptoms of polyps in the gallbladder may not appear at all. In half of the cases, the patient can only complain about a feeling of slight discomfort in the right hypochondrium, and this is at best.
Diagnostics
As with other diseases of the gallbladder, ultrasound plays a decisive role. In this case, a certain rounded formation is identified in the gallbladder, connected to the wall of the bladder, and not giving an acoustic shadow.
On the image:
- polyp
- bladder cavity
- liver tissue
Treatment
There is no other treatment other than surgery for gallbladder polyps.
- If polyps have clinical manifestations, the gallbladder must be removed regardless of the size of the polyps.
- Polyps larger than 10 mm should be removed as they pose a significant risk of malignant transformation.
- Growing polyps should be removed. To determine whether polyps are growing, a control ultrasound should be done. Polyps smaller than 10 mm and pedunculated should be monitored at least every 6 months for 2 years. Then monitoring should be done once a year for life. If any of these follow-up studies reveal that the polyp is increasing in size, it should be removed.
If the polyp does not have a stalk (spread-based polyp), control should be done once every 3 months. This is due to the fact that such polyps are more prone to malignant degeneration than polyps that have a stalk. After 2 years, control studies are also carried out every year for life. If the polyp begins to grow, it should be removed.
The problem of polyps is most often faced by women aged 30-35 years. However, it is not always possible to establish the correct diagnosis based on ultrasound results. Polyps are often confused with cholesterol stones.
What is a polyp?
A polyp is a tumor-type neoplasm that forms on the wall of the gallbladder and grows into its lumen. This disease is quite difficult to treat, especially at a late stage.
If more than 5 polyps form in the gallbladder, then this deviation is called polyposis. In other cases, neoplasms are considered solitary. Symptoms of gallbladder polyposis are more pronounced.
The peculiarity of polyps is that they are quite difficult to diagnose. This is because the signs of the development of the disease are similar to other pathological changes in the gastrointestinal tract.
Neoplasms are divided into several main types:
- Cholesterol. Such growths arise due to a violation metabolic processes in organism. Compared to other types, cholesterol polyps are treatable with medication.
- Papillomas. This is the name for benign neoplasms; if timely assistance is not provided to the patient, there is a risk of developing cancer.
- Adenomatous. Such tumor formations arise due to the inflammatory process of glandular tissues. Although they are benign, there is a high likelihood of developing cancer cells. Therefore, if there is such a diagnosis, the patient needs urgent help.
- Inflamed. Such polyps appear due to inflammation of the mucous membrane of the gallbladder, after which its tissue begins to grow.
Cholesterol polyps are the most common. Their size ranges from 2 to 7 mm. The treatment method for the disease is aimed at preserving the gallbladder. This is because its removal will significantly affect the digestive processes.
Causes
The exact causes of polyps have not yet been identified.
The mechanism of inflammation occurs as follows:
- excess bile is formed in the liver, then it accumulates in the bladder;
- when food enters the body, the muscles of the bladder contract to release bile into the intestines;
- Various pathologies affect the amount of bile, stagnation occurs, and polyps form.
This phenomenon causes a chronic inflammatory process. This happens due to constant irritation of the mucous membrane.
The formation of polyps is preceded by the following factors:
- genetic predisposition;
- gallbladder dyskinesia;
- pathology of metabolic processes;
- congenital mutations;
- inflammation in the gallbladder.
Some types of polyps are passed on from generation to generation. Moreover, they can appear on any organ.
Often the cause of polyposis is abnormalities in the functioning of the following organs:
- pancreas.
Polyps are a source of infection. Against the background of this disease, chronic cholecystitis and pancreatitis often develop.
Symptoms
Diagnosis is also complicated by the fact that signs of the presence of polyps in the gallbladder appear only in an advanced stage. The disease is discovered accidentally during a routine examination.
In rare cases they appear following symptoms polyps in the gallbladder:
- Throbbing pain in the right side. The pain occurs because, as a result of overcrowding, the muscles of the bladder are stretched. The sensations worsen after eating fatty foods or alcohol.
- Yellowness of the skin. Not only the skin, but also the sclera acquires this shade. A blood test may reveal elevated levels of bilirubin. In addition, this condition is accompanied skin itching and change in urine color.
- General discomfort in the area of the right hypochondrium. Pecking attacks may suddenly occur. In this case, the patient cannot be in one position.
- Nausea and heartburn. This condition occurs mainly in the morning, after eating, vomiting and a bitter taste in the mouth appear.
The appearance of severe pain attacks should alert you. Sometimes such symptoms are a signal that a neoplasm has transformed into a malignant form.
Symptoms are determined by the location of the polyp. It is most dangerous when the tumor forms in the bladder duct. In this case, the polyp slows down the process of bile passage, thereby causing jaundice skin.
What is the danger?
Polyps pose a serious danger to the patient's health:
- The development of a polyp is accompanied by an inflammatory process of the gallbladder, which disrupts the process of bile outflow. As a result of this phenomenon, pathologies of an irreversible nature appear.
- Due to regular stagnation of bile, intoxication of the body can occur, which negatively affects the functioning of the brain.
- The main danger is that there is a possibility of the tumor degenerating into a cancerous form.
According to statistics, in 40-45% of cases, gallbladder polyps form cancer. To reduce such risks, you need to regularly undergo examination by a specialist and reconsider your lifestyle.
Diagnostics
Testing is usually ordered after symptoms occur.
However, to establish the exact cause of the disease, it is necessary to use special equipment:
- Using ultrasound examine the cavity of the gallbladder. Polyps are visible in the form of small neoplasms attached to the wall of the bladder. Their main difference from stones is that they do not move when changing body position.
- Cholangiography method identify the exact location of the tumor and its structure. With the help of such a study, the overall condition of the mucous membranes is studied.
- Endoscopically also determine the location of the polyp. This method is prescribed if ultrasound does not accurately examine the structure of the gallbladder.
- CT scan helps to establish the stage of development of the polyp, as well as the likelihood of transition to an oncological form.
In addition, the patient is prescribed a biochemical and general blood test. There is also a need to analyze urine and feces.
Treatment
Usually, after detection of cholesterol-type polyps, a conservative treatment method with medications is prescribed. Medicines promote the resorption of tumors.
Polyps without a stem are especially dangerous. Because such inflammations most often develop into a malignant form. Therefore, patients need to be re-examined every 2-3 months.
Most experts are inclined to believe that the only effective method of treating the disease is surgical intervention.
Main indications for surgery:
- The polyp is about 10 mm in size and is actively growing. If a large neoplasm is detected, it is necessary to as soon as possible perform deletion. After the operation, the patient is registered with a doctor and must be examined at least once a year.
- When obvious symptoms of the disease appear, removal is necessary in any case, even if the polyp is small in size.
- Predisposition to cancer.
- If there are polyps not only on the gallbladder, but also in the intestines.
All patients with such tumor formations undergo constant monitoring. If the polyp is under 1 mm in size, you should still monitor its growth for several months.
Should polyps in the gallbladder be removed or not?
Only a doctor can accurately answer this question. This is because in most cases the gallbladder itself is removed.
Laparoscopy is the most gentle technique surgical intervention, after such a procedure, long-term rehabilitation is not required. Some patients undergo endoscopic polypectomy with preservation of the gallbladder.
However, this treatment method is questioned by many experts, due to the fact that after the polyps are removed, the bladder cannot perform its previous functions. In addition, the risk of recurrence of tumors increases.
Rehabilitation after surgery
The patient is prohibited from eating any food for at least 6 hours after the operation. For 10 - 12 hours you should drink only water. The next day, liquid food is introduced into the diet.
- fermented milk products;
- porridge;
- vegetable puree.
It is strictly forbidden to eat sweets and flour. Drinking alcoholic beverages is not recommended for several months. In the first hours after surgery, the patient should not get out of bed, because fainting may occur.
- lying on the bed, spread your legs and bring them together at the knees;
- sit on a chair, leaning on its back and bend several times to the left and right;
- while standing still, raise your knees high, imitating walking;
- While standing, roll from side to side.
Depending on the symptoms of polyps in the gallbladder, treatment will differ. Therefore, any exercise therapy exercises must be previously agreed with the attending physician.
ethnoscience
If there are indications for surgery, treat polyps with folk remedies useless. However conservative therapy Can be supplemented with some recipes.
Decoctions of the following herbs are used as auxiliary treatment:
- sagebrush;
- celandine;
- milk thistle;
- rose hip;
- gray blackberry;
- series;
- dill.
Prevention
If you have polyps in the gallbladder, as well as during the rehabilitation period after surgery, you should follow the recommendations of specialists:
- Avoid long breaks between meals. It is necessary to eat food in small portions every 3 hours so that bile does not stagnate.
- Avoid overly spicy and salty foods. All food should be of moderate temperature, not too cold or hot.
- Drink at least 2 liters of water per day. Limit the consumption of drinks containing sugar.
- After surgery, it is recommended to consume steamed dishes in ground form.
- Should be abandoned physical activity, especially after eating.
- Do not abuse bad habits.
- Eat fiber-rich foods daily.
- To walk outside.
Physical inactivity quickly leads to disruption of the body's metabolic processes, which significantly reduces immunity. This disease, in turn, provokes the development of cholesterol polyps.
It is believed that, according to ultrasound, 6% of the population is diagnosed with polyps in the gallbladder. And in 80% of cases, they are found in women after 35 years of age. However, everyone knows that ultrasound diagnostics It is not always possible to accurately determine the nature of the tumor tissue, and there are many cases when such a diagnosis is erroneously established, when in fact the patient does not have polyps in the gall bladder, but loose cholesterol stones, the growth dynamics of which must be monitored.
How are gall polyps diagnosed?
The most accessible and cheapest diagnostic method is ultrasound. In this case, the doctor detects single or multiple round formations that are associated with the wall of the gallbladder and there is no acoustic shadow. Another method, the most promising and interesting, is endoscopic ultrasonography.
This is a flexible endoscope with an ultrasound sensor at the end; for examination, the patient must swallow the device, which enters the duodenum, which is located near the gallbladder. This device uses frequencies 2 times higher than conventional ultrasound, so endoscopic ultrasonography shows a higher-quality image, distinguishing the walls of the gallbladder layer by layer.
What types of polyps are there?
The causes of gall polyps are still not known and are only theoretical guesses. According to many experts, polyps are asymptomatic, and if symptoms are present, the diagnosis should be reconsidered in favor of cholelithiasis, concomitant diseases of the digestive system, such as reactive pancreatitis, etc. Today, these neoplasms are divided into the following groups:
- Cholesterol polyps - pseudotumors
It is cholesterol tumors that are mistaken for polyps on ultrasound. They represent the deposition of cholesterol as an elevation of the mucous membrane of the bladder. The accumulation of cholesterol occurs against the background of lipid metabolism disorders and often contains calcified inclusions, so they give the impression of gall bladder stones fixed to the walls.
- Inflammatory polyps are also pseudotumors
These neoplasms are an inflammatory reaction of the gallbladder mucosa, manifested by the growth of the internal tissue of the affected bladder.
- Gallbladder adenoma, as well as papillomas and papillary neoplasms are true polyps
These are benign neoplasms, however, in 10-30% of patients their malignancy is observed, and often the development of such polyps occurs asymptomatically or a combination of cholelithiasis with chronic cholecystitis(see also). The reasons for the development of oncology against the background of such neoplasms remain largely unclear.
The most common polyps are cholesterol ones, which can be treated conservatively
There are two expert opinions regarding what is considered cholesterol gall polyps. Some argue that they can be in the form of inclusions that create a diffuse mesh, usually they are 1-2 mm, or they can be larger 2-4 mm and look like outgrowths from the submucosal layer of the bladder, while its ultrasonographic signs are smooth contours and wide base. Larger cholesterol neoplasms from 3-4 mm to 5-7 mm can also be detected, they are located on a thin stalk, with an even contour, do not give an acoustic shadow during examination, even larger ones - over 10 mm have a scalloped contour and this cholesterol polyp hypoechoic.
Another opinion of doctors is that 95% of polyps described on ultrasound are not actually polyps, but are considered loose cholesterol stones. Yes, indeed, on ultrasound they look like polyps, even multiple, but they almost never give any pain, and if the patient complains of symptoms of cholecystitis, cholelithiasis, it is the stones that cause severe pain and ailments.
If there is the slightest chance of preserving the organ, they should always be used; if there is a polyp in the gallbladder, treatment should not be aimed at 100% removal of the bladder. There are no useless organs in the body. By removing the bile storage, from which bile flows through the duct to participate in digestion, significant changes occur in the entire digestive process.
Therefore, if cholesterol polyps are detected by ultrasound, the doctor may recommend starting drug therapy, dissolve the stones with ursodeoxycholic or chenodeoxycholic acids (ursofalk, ursosan), that is, with special preparations for 2-3 months and do a control ultrasound. Based on the dynamic results, one can draw conclusions: if a positive effect occurs, then the dissolution of stones should be continued; if there is no positive dynamics, the issue of surgical treatment should be addressed.
These conclusions are made by surgeons when, after treating gallbladder polyps, surgically, the described polyps according to ultrasound results in 95% of cases were loose parietal cholesterol stones, which can give symptoms of cholelithiasis.
Therefore, in consultation with the attending physician, courses of drugs that improve bile rheology and dilute bile (ursosan, ursosan, ursofalk) can be carried out. The course and dosage is determined by the doctor depending on the patient’s weight, and treatment can also be supplemented choleretic herbs, such as agrimony. In addition, you should follow diet No. 5, 4 meals a day.
However, of course, one should also remember about the possible malignancy of an adenomatous polyp, papilloma or papillary neoplasm. To do this, you should perform a control ultrasound every six months, preferably with the same specialist and on the same machine. If the tumor grows by 2 mm per year, surgery is indicated, since the risk of malignancy is high; if there is no growth, continue observation. In each specific clinical case, only a doctor or a council of doctors determines the advisability of surgical removal gallbladder in the presence of polyps.
Symptoms of gallbladder polyps
As we wrote above, polyps are asymptomatic, patients have no specific complaints. Very rarely there may be pain in the epigastric region or discomfort in the right hypochondrium, intolerance to certain types of food, and they are often discovered by chance on an ultrasound.
Treatment of polyps
The opinion of most experts when polyps are detected in the gallbladder is surgery, that is, only surgical intervention, 100% of the indications for which are: 
- A polyp measuring less than 10 mm on a pedicle is monitored every six months for 2 years and once a year for life; if it grows, removal is indicated. However, some doctors insist on the need for surgery immediately after detection of a large tumor.
- During development clinical symptoms polyps - removal is indicated regardless of their size and type.
- Any polyps larger than 10 mm are recommended to be removed due to high risk its degeneration into cancer.
Considering the oncological tension, there is also such a tactic for managing doubtful clinical cases— it is based on constant monitoring of the size of even small polyps. If it is less than 1 mm, there are no indications for removal, but most doctors insist on monthly ultrasound monitoring for 6 months, then every 3 months, then six months and then annually. We remind you that the rapid growth of a polyp is considered to be 2 mm per year.
Among modern methods surgical intervention for the removal of a polyp or gallbladder, the following methods are distinguished:
- LCE - Videolaparoscopic cholecystectomy - modern endoscopic technologies, the most gentle operations, but are performed only in certain cases (see)
- OLCE - open laparoscopic cholecystectomy, performed from a mini-access, using “Mini-Assistant” instruments
- Traditional cholecystectomy, TCE, is performed from an oblique or median laparotomy approach
- Endoscopic polypectomy - the long-term results and consequences of such an operation have not been thoroughly studied and it is not yet used often.
For reference:
- The incidence of gallbladder cancer is 0.27-0.41% among all cancers
- It occurs 2 times more often in women than in men
- Among gastrointestinal oncologies, gallbladder cancer ranks 5th (after stomach, pancreas, colon and rectum cancer)
- Among oncology of organs of the hepato-pancreatic-duodenal zone - 2nd place after pancreatic cancer
- The risk of development increases after 45-50 years, the peak incidence is 56-70 years
- During operations on the biliary tract it occurs in 1-5% of cases.
