--- title: Gallbladder polyps: who gets watched, and who gets operated on publication: Medical Insights Korea section: columns category: Gallbladder canonical_url: https://medicalinsightskorea.com/columns/surgery/gallbladder-polyps-who-is-watched-and-who-is-operated-on author: Jong Je Sung, Specialist in General Surgery author_type: contributing clinician, not editorial staff author_practice: Min Hospital author_credential_issued_by: Ministry of Health and Welfare, Republic of Korea author_profile: https://medicalinsightskorea.com/authors/jong-je-sung editorial_note: Signed opinion by the named clinician. Written by them, edited and translated by Medical Insights Korea. Not a reported article, and not a clinical review of this publication's reporting. published: 2026-09-12T08:00:00+09:00 modified: 2026-09-12T08:00:00+09:00 content_type: opinion license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Gallbladder polyps: who gets watched, and who gets operated on A surgeon on why the word covers two different things, what the ultrasound report is actually being read for, and why the size on this year's scan matters less than the size on the last one. ## Answer A gallbladder polyp is not one disease — the word covers cholesterol deposits on the gallbladder wall, which are not tumours, and true neoplastic lesions made of proliferating cells — and because ultrasound cannot separate them with certainty, management is decided from size, number, shape, gallbladder wall changes and above all change over time: a pooled analysis of 30 studies found size of 10 mm or more, sessile shape, being a single polyp, coexisting gallstones and wall thickening each significantly associated with neoplastic polyps, while a cohort followed for a median of 66 months found the opposite reassurance — polyps shrank at a median of 0.3 mm a year, 46 percent were no longer visible at follow-up, and one patient in 253 developed gallbladder cancer — and when surgery is judged necessary the whole gallbladder is removed rather than the polyp alone, because there is no endoscopic route to take a polyp out of a gallbladder the way one is taken from the stomach or colon. ## Key takeaways - “Gallbladder polyp” describes any lesion projecting from the gallbladder wall, not a single disease. Cholesterol polyps, the commonest kind, are deposits rather than tumours. - Gallbladder polyps are common in Korea. Among 21,734 people attending a health screening centre on Jeju, prevalence was 9.8 percent in one city and 8.9 percent in the other. - In a meta-analysis of 30 studies and 8,953 patients, eight ultrasound features were significantly associated with neoplastic polyps, including size of 10 mm or more, sessile shape, a single polyp, coexisting gallstones and gallbladder wall thickening. - Size of 10 mm or more had the highest sensitivity of any single feature at 0.79, which is why it functions as a threshold — but it is one feature among eight, not a rule. - Among 144 patients operated on for polyps of 10 to 15 mm, 13.89 percent proved neoplastic; maximum diameter and broad-based shape were the independent predictors. - Those percentages come from patients who had surgery, not from everyone with a polyp. In 253 incidentally detected polyps followed for a median of 66 months, one patient developed gallbladder cancer — 0.4 percent. - In the same followed-up cohort the median growth rate was minus 0.3 mm a year and 46 percent of polyps were no longer detectable at follow-up. - There is no endoscopic way to remove a gallbladder polyp on its own, so when treatment is needed the gallbladder is removed with it. - Symptoms are not a guide. Most gallbladder polyps cause none, and right upper abdominal pain or indigestion cannot be attributed to a polyp with confidence. ## Full article When a health checkup reports a gallbladder polyp, patients divide into two reactions. Some worry that it will turn into cancer. Others, seeing no symptoms, treat it as nothing. Gallbladder polyps are indeed found incidentally at checkups very often, and a substantial proportion never cause a problem. That does not mean every one of them is managed the same way. For some patients periodic ultrasound is enough; others need further imaging, or surgery. Understanding the difference starts with knowing that “gallbladder polyp” does not name a single disease. ### Two different things under one word Any lesion protruding inwards from the inner wall of the gallbladder is called a polyp, and their nature can differ entirely. The commonly found kind is the cholesterol polyp: cholesterol from the bile accumulating on the gallbladder wall until it looks like a polyp. That is a different thing from a tumour formed by cells actually multiplying. There are also true polyps, such as adenomas, made by genuine cell proliferation, and in some of those the possibility of malignant change has to be considered. The problem is that from the moment a polyp is found at a checkup, telling those two apart perfectly is not easy. So we look at the size and number of the polyp on ultrasound, its shape, and changes in the gallbladder wall, and judge the risk from those. If there is a previous scan, whether the size has changed against it is important information too. The question is not simply whether a polyp is present, but what it looks like and how it is changing. > **What the imaging features are actually worth** > A meta-analysis of 30 studies covering 8,953 patients tested nine ultrasound features against pathology. Eight were significantly associated with neoplastic polyps: size of 10 mm or more, sessile shape, being a single polyp, coexisting gallstones, hypoechogenicity, gallbladder wall thickening, absence of hyperechoic spots, and vascularity. Size of 10 mm or more had the highest sensitivity of the nine at 0.79, which is exactly why it works as a threshold and exactly why it is not a rule: a feature that catches four out of five neoplastic polyps still misses one. The Korean Society of Abdominal Radiology published recommendations in 2025 covering 24 questions on how these findings should be interpreted, reported and followed, with the stated aim of reducing unnecessary follow-up and unnecessary surgery. ### Size, and what sits around it One of the important criteria among these is size. Generally, if a polyp is small and shows typical benign features, it is often watched for a period with ultrasound. Conversely, the larger it becomes, the more carefully the possibility of a neoplastic lesion has to be considered. A polyp around 10 mm in particular can be an important criterion in judging whether to operate. But a single number does not decide surgery on its own. Even where the size is small, further evaluation is needed if the polyp is sessile, with a broad base attached to the wall, or if the gallbladder wall has thickened, or if it keeps growing on follow-up. The patient's own circumstances are weighed alongside. Where there are factors that can raise risk — older age, or other gallbladder disease such as stones present at the same time — the size and shape of the polyp have to be judged together with them. That is why, with a gallbladder polyp of the same size, follow-up is appropriate for one person and more active investigation or treatment is needed for another. ### Why the operation removes the gallbladder If surgery is judged necessary because of a gallbladder polyp, what is performed is not the excision of the polyp but a cholecystectomy — removal of the whole gallbladder. This is different from the way a polyp is taken from the stomach or the colon with an endoscope and sent for histology. Structurally, a polyp cannot be removed from the gallbladder on its own, so when there is a possibility of malignancy or treatment is required, the approach is to take the gallbladder with it. That is what makes the decision consequential in both directions: not removing a gallbladder unnecessarily, while not missing a lesion that needs treating. > **Two percentages that describe different people** > Among 144 patients whose 10 to 15 mm polyps were removed and examined, 13.89 percent were neoplastic. That figure describes patients who were operated on — already selected for surgery because something about them looked concerning — and it is not the risk facing someone whose checkup mentions a polyp. A cohort of 253 incidentally detected polyps followed for a median of 66 months gives the other side: the median growth rate was minus 0.3 millimetres a year, 46 percent were no longer detectable on later scans, two patients reached an indication for surgery, and one developed histologically confirmed gallbladder cancer — 0.4 percent. Both numbers are true. Reading the first as though it were the second is what turns a checkup line into a fear, and what makes people ask for a gallbladder to be removed that did not need removing. ### Symptoms will not tell you What patients should be careful of here is the thought that it must be fine because there are no symptoms. Most gallbladder polyps cause no particular symptoms. Even where there is pain in the right upper abdomen or poor digestion, it is difficult to conclude that a polyp is necessarily the cause. So rather than judging the risk of a polyp by the presence or absence of symptoms, what has to be examined is the features confirmed on imaging and how they change over time. ### What to take off the report If a checkup finds a gallbladder polyp, the first thing to confirm on the result sheet is the size. If possible, check how many there are and what shape they are, and if there is a previous ultrasound, compare against the old size. After that, set a follow-up interval appropriate to the present state and confirm the change. 1. The size, in millimetres, as reported. 2. The number of polyps, and whether any is described as sessile or broad-based. 3. Whether the gallbladder wall is described as thickened, and whether stones are also present. 4. The size on the previous scan, if there is one. 5. The date of the next check. If you use a different screening centre each year, keeping the previous results is particularly helpful. Having the earlier record is what makes it possible to tell whether this is a newly appeared polyp or one that has not changed in several years. Finding a gallbladder polyp is not a reason to worry immediately about cancer, or to think first about surgery. Nor is it a reason to skip later checks simply because it is small. What matters with a gallbladder polyp is not only the size at the moment it is found, but what shape it has and how it changes as time passes. Picking out in good time the polyp that needs treatment, while avoiding the operation that is not needed — that is the most important principle in managing them. **The operation this decision leads to, when it leads there** - [Not every gallbladder is the same operation](https://medicalinsightskorea.com/columns/surgery/not-every-gallbladder-is-the-same-operation) — The same surgeon on what makes one cholecystectomy harder than another. - [Do gallstones without symptoms need surgery?](https://medicalinsightskorea.com/faq/asymptomatic-gallstones-need-surgery) — The neighbouring question, asked of stones rather than polyps. ## Sources - Chang W, Lee S, Kim YY, Park JY, Jeon SK, Lee JE, Yoo J, Han S, et al. Interpretation, reporting, imaging-based workups, and surveillance of incidentally detected gallbladder polyps and gallbladder wall thickening: 2025 recommendations from the Korean Society of Abdominal Radiology. Korean Journal of Radiology 2025;26(2):102-134. doi:10.3348/kjr.2024.0914. PMID:39898393. https://doi.org/10.3348/kjr.2024.0914 - Lee S, Chang W, Kim YY, Park JY, Jeon SK, Lee JE, Yoo J, Han S, et al. Ultrasound imaging features associated with neoplastic gallbladder polyps: a systematic review and meta-analysis. Korean Journal of Radiology 2026;27(4):332-343. doi:10.3348/kjr.2025.1126. PMID:41776850. https://doi.org/10.3348/kjr.2025.1126 - Zhou L, Gou L, Ning D, Liang Y, Yu J. Maximum polyp diameter and broad-based morphology predict neoplastic gallbladder polypoid lesions in the 10-15 mm gray zone: a retrospective study. European Journal of Radiology 2026;204:113123. doi:10.1016/j.ejrad.2026.113123. PMID:42551305. https://doi.org/10.1016/j.ejrad.2026.113123 - Heinrich S, Ten Thoren PJ, Behrendt P, Hagenah J, Wedemeyer H, Potthoff A, Maasoumy B. Dynamic growth risk of incidentally detected gallbladder polyps: a retrospective, single-center analysis. PLOS ONE 2025;20(12):e0337890. doi:10.1371/journal.pone.0337890. PMID:41433259. https://doi.org/10.1371/journal.pone.0337890 - Kwon OS, Kim YK, Kim HJ. Retrospective study of the prevalence and associated factors of gallbladder polyps among residents of two Korean cities. Journal of Clinical Medicine 2024;13(8):2290. doi:10.3390/jcm13082290. PMID:38673563. https://doi.org/10.3390/jcm13082290 ## Citation Jong Je Sung (2026). "Gallbladder polyps: who gets watched, and who gets operated on". Medical Insights Korea. https://medicalinsightskorea.com/columns/surgery/gallbladder-polyps-who-is-watched-and-who-is-operated-on Retrieved from https://medicalinsightskorea.com/columns/surgery/gallbladder-polyps-who-is-watched-and-who-is-operated-on