The POLYP-study : Guideline Adherence Leads to Overtreatment of Gallbladder Polyps

Gallbladder (GB) polyps are common but risk of malignancy remains low. Management guidelines rely primarily on polyp size as an indication for cholecystectomy. The surgical threshold with polyps >1 cm remains controversial and is proven to be insufficient. Guideline adherence remains sub-optimal according to the 2017 and 2021 guidelines; only 48.4% and 59.7% of patients reaching indication for cholecystectomy, underwent surgical treatment. Conservative adherence was even worse, with adequate follow-up duration after first visit in only 38.9% and 42.6% of patients following 2017 and 2021 guidelines. While guideline adherence remains sub-optimal, strict adherence to the guideline may paradoxically result in overtreatment and futile cholecystectomies. The aggressive management of small GB polyps leads to excessive costs and unnecessary follow-up imaging, whereas the malignant potential of these polyps remains very small. This study underscores the importance of refining pre-operative patient selection and identification of potentially neoplastic polyps