Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE.

Autor: Foley KG; Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK. Kieran.Foley@wales.nhs.uk., Lahaye MJ; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Thoeni RF; Department of Radiology and Biomedical Imaging, University of California, San Francisco Medical School, San Francisco, CA, USA., Soltes M; 1st Department of Surgery LF UPJS a UNLP, Kosice, Slovakia., Dewhurst C; Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland., Barbu ST; 4th Surgery Department, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania., Vashist YK; Clinics of Surgery, Department General, Visceral and Thoracic Surgery, Asklepios Goslar, Germany., Rafaelsen SR; Department of Radiology, Clinical Cancer Centre, Vejle Hospital, University of Southern Denmark, Odense M, Denmark., Arvanitakis M; Department of Gastroenterology, Erasme University Hospital ULB, Brussels, Belgium., Perinel J; Department of Hepatobiliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France., Wiles R; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK., Roberts SA; Department of Radiology, University Hospital of Wales, Cardiff, UK.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2022 May; Vol. 32 (5), pp. 3358-3368. Date of Electronic Publication: 2021 Dec 17.
DOI: 10.1007/s00330-021-08384-w
Abstrakt: Main Recommendations: 1. Primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound. Routine use of other imaging modalities is not recommended presently, but further research is needed. In centres with appropriate expertise and resources, alternative imaging modalities (such as contrast-enhanced and endoscopic ultrasound) may be useful to aid decision-making in difficult cases. Strong recommendation, low-moderate quality evidence. 2. Cholecystectomy is recommended in patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery. Multidisciplinary discussion may be employed to assess perceived individual risk of malignancy. Strong recommendation, low-quality evidence. 3. Cholecystectomy is suggested for patients with a polypoid lesion and symptoms potentially attributable to the gallbladder if no alternative cause for the patient's symptoms is demonstrated and the patient is fit for, and accepts, surgery. The patient should be counselled regarding the benefit of cholecystectomy versus the risk of persistent symptoms. Strong recommendation, low-quality evidence. 4. If the patient has a 6-9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery. These risk factors are as follows: age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). Strong recommendation, low-moderate quality evidence. 5. If the patient has either no risk factors for malignancy and a gallbladder polypoid lesion of 6-9 mm, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year and 2 years. Follow-up should be discontinued after 2 years in the absence of growth. Moderate strength recommendation, moderate-quality evidence. 6. If the patient has no risk factors for malignancy, and a gallbladder polypoid lesion of 5 mm or less, follow-up is not required. Strong recommendation, moderate-quality evidence. 7. If during follow-up the gallbladder polypoid lesion grows to 10 mm, then cholecystectomy is advised. If the polypoid lesion grows by 2 mm or more within the 2-year follow-up period, then the current size of the polypoid lesion should be considered along with patient risk factors. Multidisciplinary discussion may be employed to decide whether continuation of monitoring, or cholecystectomy, is necessary. Moderate strength recommendation, moderate-quality evidence. 8. If during follow-up the gallbladder polypoid lesion disappears, then monitoring can be discontinued. Strong recommendation, moderate-quality evidence.
Source and Scope: These guidelines are an update of the 2017 recommendations developed between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). A targeted literature search was performed to discover recent evidence concerning the management and follow-up of gallbladder polyps. The changes within these updated guidelines were formulated after consideration of the latest evidence by a group of international experts. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.
Key Point: • These recommendations update the 2017 European guidelines regarding the management and follow-up of gallbladder polyps.
(© 2021. The Author(s).)
Databáze: MEDLINE
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