A 42-year-old woman undergoes ultrasound for right upper quadrant discomfort. A single well-defined gallbladder polyp measuring 11 mm is seen. She has no other symptoms and no risk factors. The most appropriate management is:

• A Annual ultrasound surveillance
• B Endoscopic ultrasonography and follow-up only if it exceeds 15 mm
• C Repeat ultrasound after 3 months, then yearly if unchanged
• D Laparoscopic cholecystectomy ✓

Explanation

Gallbladder polyps of 10 mm or more carry a meaningful risk of being malignant, and current consensus guidelines recommend cholecystectomy for any polyp of 10 mm or larger regardless of symptoms or risk factors. Polyps of 6 to 9 mm are managed by surveillance, with surgery reserved for those who have risk factors such as age above 50, primary sclerosing cholangitis, Indian ethnicity, or a sessile morphology. Annual surveillance alone would delay diagnosis of a malignancy here.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.