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Finding 'em? Following 'em? Fixing 'em?  Comment on “Risk and Cost-Effectiveness of Surveillance Followed by Cholecystectomy for Gallbladder Polyps”

Jonathan Koea, MD, FRACS
Arch Surg. 2012;147(12):1084. doi:10.1001/archsurg.2012.1959.
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By their own admission, the article by Cairns et al1 will not change current clinical practice but it starkly focuses the issues surrounding the management of gallbladder polyps. More than half of ultrasonographically detected polypoid gallbladder masses are not adenomatous polyps but benign lesions such as cholesterol deposits or gallstones with no malignant potential. Even among adenomatous polyps, the rate of malignant change is unclear. This uncertainty is reflected in referral patterns where nearly 50% of all polyps in their series were neither discussed at a multidisciplinary meeting, referred for hepatobiliary specialist review, or even followed up. Only 7% of polyps that were followed up increased in size. Only 4% of resected polyps were potentially malignant or cancerous.

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