In this episode of PodMD, General Surgeon and Gastrointestinal Endoscopist Dr Manzoor Abbas will be discussing the topic of gallbladder polyps. We discuss what gallbladder polyps are, how they typically present, risk factors, treatment options and more.
- Transcript
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Today I’d like to welcome to the PodMd studio Dr Manzoor Abbas.
Dr Manzoor Abbas is a General Surgeon and Gastrointestinal Endoscopist based in the Gold Coast with a special interest in General surgery and Gastrointestinal endoscopy.
He has trained and worked in hospitals around the globe including the United States of America, New Zealand, United Arab Emirates, India and Australia.
Prior to arriving in Australia, Dr Abbas was a qualified General and Vascular Surgeon from India working as a research international associate at the world-renowned Mayo Clinic in Rochester Minnesota.Dr Abbas also has a keen interest in research and has published well over 20 publications in noted medical journals in addition to having authored chapters in books. He is currently associated with both Bond and Griffith University on the Gold Coast and a regular tutor of junior doctors and medical students.
Today, we’ll be discussing the topic of gallbladder polyps.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD. If you do have a patient on whom you require specific advice then please seek advice from a colleague with appropriate expertise in that area.
Manzoor, thanks for talking with us on PodMD today.
Manzoor: Thank you for having me.
The topic of today’s discussion is gallbladder polyps. Manzoor, can you describe for our listeners what gallbladder polyps are?
Manzoor: Gallbladder polyp is just an elevation of the gallbladder wall that protrudes into the lumen, akin to colon polyps that people talk about. It is usually found from an ultrasound rather than anything. But the main concern with a gallbladder polyp is whether it has got a malignancy potential.
Question 1
How would a patient with gall bladder polyp typically present?Manzoor: Well, like I just mentioned, it’s basically an imaging finding from an ultrasound scan, but most patients would have presented to the GPs with what we call a biliary colic or biliary pain. These patients would have had pain in the right upper abdomen following eating something fatty that might have brought it to their attention and then they follow up with the GP and then an ultrasound showing the gallbladder polyp. But sometimes, it can have symptoms of what we call chronic dyspeptic symptoms such as nausea, vomiting, bloating that again alerts them to see a GP and then again, we find it through the ultrasound.
Question 2
What are the risks or efficacy of this condition?Manzoor: With the risk factors for the gallbladder polyp, a risk is gallbladder cancer. We have seen in the studies that the most common ethnic groups are people from the subcontinent such as Northern India, Asia and also in the Indigenous population of Inner North and South America. These are one of the risk group patients, and also patients who are about the age of 50, that is another risk group.
The polyp itself, the size of the polyp, dictates the risk of malignancy. So, the bigger the size of the polyp, the higher the risk it stands. So, these are some of the risks of the condition essentially.
Question 3
What are some of the treatment options?Manzoor: Now, treatment depends on the ethnicity of the patient, the age of the patient and the size of the polyp. If you look at many of the studies which I have described based on the size of the polyp, you would say any polyp that is 10mm, that is a centimetre and about, should have surgery. But there is always a grey line when the polyps are smaller in size. When we say smaller in size we are talking about a polyp which is between 5mm to 10mm and polyps which are less than 5mm. A polyp less than 5mm, there have not been many studies to argue that patients need a treatment for this, but there is always a debate for polyps between 5mm and 10mm.
Now, the treatment can be as simple as a key-hole operation, a laparoscopic cholecystectomy, removing the gallbladder with the polyp and then getting it assessed in pathology.
Question 4
In terms of referring, when should a GP typically or ideally refer a patient?Manzoor: We talked about the risks of the gallbladder polyp, again, if they find patients with these symptoms and have had suspicions of a gallbladder polyp, if there was that certain size and if they were from that certain background like we talked about – North Indian, East Asian or North or South American ethnic population or Indigenous population – I should say, they should be referred.
Patients if they have a polyp of more than 5mm, they should be referred. Also patients that are about 50 years are at a higher risk and they should be referred so that a discussion can be had with the patient about what next treatment options can be had for it.
Question 5
In terms of the role of the GP, what role does the GP play in the treatment of this condition?Manzoor: GPs have an important role, really, because patients with the symptoms first present to them. Prompt recognition of the symptoms leading to imaging. If they do find that the symptoms do relate to the imaging, you know, like they have a gallbladder but just don’t have polyps, that is an important part of the GPs role to then assist the patient and refer them to a specialist for further treatment.
Second thing is sometimes when the polyp is smaller in size, which does not need a cholecystectomy or removal of the gallbladder, then a GP plays a wider role in surveillancing the polyp but regular ultrasounds, generally speaking every year. When the polyp gets to a size that needs treatment they promptly refer to the specialist. I think that there is an important role for GPs from the surveillance point of view.
Question 6
Thank you for your time here today Manzoor in the PodMD studio. To sum it up for us, could you please identify the three key take home messages from today’s podcast on gallbladder polyps?Manzoor: Three messages I would say are, first thing being polys are mostly benign, but they have a risk of becoming malignant based on the size which is an important point to take.
The second one is who are the risk groups – that is age, more than 50, to people that are from the subcontinent, that is North India, South East Asia and also the indigenous ethnicity of North and South America. The third is the size of the polyp, of more than 5mm in size – these are risk factors as a second take home message.
The third take-home message is that the treatment can be as simple as a laparoscopic cholecystectomy to avoid gallbladder cancer in the future.
Thank you very much again for your time and the insights you’ve provided; it’s been great.
Manzoor: Thank you and good to be here.
