Gallbladder Polyps: Risk Stratification and Surgical Outcomes in the Era of Advanced Imaging

Abstract

Background: Gallbladder polyps are increasingly detected due to the widespread use of high-resolution abdominal ultrasonography and cross-sectional imaging. Although most gallbladder polyps are benign cholesterol polyps with negligible malignant potential, a small proportion represents adenomatous lesions or early gallbladder carcinoma. Accurate risk stratification based on clinical characteristics and imaging features is essential to identify patients who would benefit from cholecystectomy while avoiding unnecessary surgery in those with low-risk lesions. Recent advances in imaging modalities have improved the characterization of gallbladder polyps; however, their impact on surgical decision-making and postoperative outcomes remains an area of ongoing investigation.
Aim: To evaluate the role of clinical and imaging-based risk stratification in the management of gallbladder polyps and to assess surgical and histopathological outcomes in patients undergoing cholecystectomy.
Methods: A prospective hospital-based observational cohort study was conducted in the Department of General Surgery, Jawaharlal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, from January 2024 to December 2025. A total of 100 consecutive patients diagnosed with gallbladder polyps on abdominal ultrasonography were enrolled. Clinical presentation, demographic characteristics, laboratory investigations, ultrasonographic findings, and advanced imaging findings where indicated were recorded. Patients were stratified into low-, intermediate-, and high-risk categories according to established imaging and clinical risk factors. Patients meeting surgical criteria underwent laparoscopic or open cholecystectomy, and postoperative outcomes and histopathological findings were analysed. Statistical analysis was performed using chi-square test, Student’s t-test, one-way ANOVA, logistic regression, and receiver operating characteristic (ROC) analysis.
Results: Among the 100 enrolled patients, the mean age was 48.6 ± 13.2 years, and 58% were females. Solitary polyps were identified in 62% of patients, while 38% had multiple polyps. Polyps measuring ≥10 mm were observed in 28% of patients. Seventy-two patients underwent cholecystectomy based on predefined surgical indications. Histopathological examination revealed cholesterol polyps in 48.6%, adenomatous polyps in 26.4%, adenomyomatosis in 12.5%, inflammatory polyps in 6.9%, and gallbladder adenocarcinoma in 5.6% of surgical specimens. Increasing polyp size, sessile morphology, patient age ≥60 years, and focal gallbladder wall thickening were independently associated with neoplastic pathology (p<0.05). Patients undergoing laparoscopic cholecystectomy demonstrated favourable perioperative outcomes with low postoperative complication rates.
Conclusion: Risk stratification incorporating clinical factors and advanced imaging characteristics effectively identifies patients at increased risk of neoplastic gallbladder polyps. Appropriate patient selection for cholecystectomy facilitates early diagnosis of premalignant and malignant lesions while reducing unnecessary surgical intervention in low-risk patients. Advanced imaging serves as a valuable adjunct to conventional ultrasonography in optimizing management decisions.