Polyps in the gall bladder: treatment, symptoms,deletion

Update: December 2018

According to ultrasound data, it is estimated that 6% of the population is diagnosed
polyps in the gall bladder. And in 80% of cases, they are found in
women over 35 years old. However, we all know that ultrasound
diagnostics can not always accurately determine the nature of the tissue
neoplasms and many cases where erroneously
such a diagnosis is established when in fact the patient has
gall not polyps, but loose cholesterol stones, behind the dynamics
growth that needs to be monitored.

How are polyps in galls diagnosed?

The most affordable and cheapest method of diagnosis is ultrasound. With
this doctor discovers a rounded formation of single or
multiple which are associated with the gallbladder wall and when
This missing acoustic shade. Another method, the most
promising and interesting is endoscopic
ultrasonography.

This is a flexible endoscope with an ultrasonic sensor at the end, for
examination of the patient must swallow the device, which
enters the duodenum, which is near
gallbladder. This device uses a frequency of 2 times
larger than normal ultrasound, so endoscopic
ultrasonography shows a higher quality image
послойно различая стенки gallbladder.

What are polyps?

Withчины возникновения полипов желчного до сих пор не известны и
are only theoretical guesses. According to many
specialists, polyps are asymptomatic, and in the presence of symptoms
the diagnosis in favor of cholelithiasis should be reviewed,
associated diseases of the digestive system, such as
as reactive pancreatitis, etc. To date, these
neoplasms are divided into the following groups:

  • Cholesterol polyps – pseudo-tumors

That cholesterol neoplasms take on ultrasound for
polyps. They represent cholesterol deposition as elevation.
mucous membrane of the bladder. An accumulation of cholesterol occurs in the background.
lipid metabolism disorders and often contain calcined
inclusions, so they give the impression of gallstones,
fixed to the walls.

  • Inflammatory polyps – also pseudo-tumors

These tumors are an inflammatory reaction of the mucous membranes.
gall, manifested by the growth of the internal tissue of the affected
a bubble.

  • Adenoma of the gallbladder, as well as papillomas and papillary
    neoplasms are true polyps

These are benign neoplasms, however, in 10-30% of patients.
their malignancy is observed, and often the development of such
polyps occur asymptomatically or a combination is possible
gallstone disease with chronic cholecystitis (see
Cholecystitis symptoms and treatment, as well as a diet for stones in the gall
bubble). Withчины развития онкологии на фоне таких новообразований
in many ways are not clear.

The most common polyps are cholesterol, which can be treated.
conservatively

There are two expert opinions that
consider cholesterol polyps gall. Some claim they are
may be in the form of inclusions that create a diffuse mesh,
usually they are 1-2 mm, or be larger 2-4 mm and look like
outgrowths from the submucosal layer of the bladder, while its
The ulrasonographic features are smooth contours and
broad base. Larger ones may also be detected.
холестериновые новообразования от 3-4 мм  до 5- 7 мм, они
located on a thin leg, with a smooth contour, do not give
акустической тени при исследовании, еще крупнее —  свыше 10 мм
have scalloped contour and this cholesterol polyp
hypoechogenic.

Another opinion of doctors is that 95% of those described in
Ultrasound of polyps, they are not really, but are considered loose
cholesterol stones. Yes indeed, on ultrasound they look like
polyps, even as multiple, but they almost never give
no pain, and if the patient complains of cholecystitis symptoms,
gallstone disease, namely stones and cause severe pain and
malaise.

If there is the slightest chance of preserving the organ, they should always
use, in the presence of a polyp in the gall bladder, the treatment is not
должно быть направлено на 100% deletion a bubble. Useless organs
in the body does not exist. Removing the bile storage from which
bile enters the duct to participate in digestion – occur
significant changes in the whole process of digestion.

Therefore, if cholesterol is detected by ultrasound
polyps, the doctor may recommend starting drug therapy,
dissolve ursodeoxycholic or chenodeoxycholic stones
acids (Ursofalk, Ursosan), that is, special preparations in
2-3 months and make a control ultrasound. According to the result in
dynamics can be inferred if a positive effect has
place – you should continue dissolving the stones, if
There are no positive dynamics – to resolve the issue of surgical
treatment.

These conclusions are made by surgeons when, after treatment of biliary polyps
bladder surgically, described polyps by ultrasound results in
95% of cases were loose near-wall cholesterol stones,
which can give symptoms of gallstone disease.

Therefore, in consultation with your doctor, you can conduct courses
drugs that improve the rheology of bile and thinning bile
(Ursosan, Ursosan, Ursofalk). The course and dosage is determined by the doctor in
depending on the weight of the patient, and the treatment can be supplemented
choleretic herbs such as dogrose, immortelle, agrimony.
In addition, you should follow the diet number 5, 4 meals a day.

However, of course, one should remember about the possible malignancy.
adenomatous polyp, papilloma or papillary neoplasm.
To do this, every six months to perform a control ultrasound,
preferably at the same specialist and on the same
machine. In case of neoplasm growth of 2 mm per year – shown
operation, since there is a high risk of it being malignant, in the absence
growth – to continue to observe. In each specific clinical
case, only a doctor or a council of doctors determines
expediency of surgical removal of the gallbladder
in the presence of polyps.

Symptoms of gallbladder polyps

As we wrote above, polyps are asymptomatic, no
There are no specific complaints in patients.  Very rarely can
pain in the epigastric region or discomfort in the right
hypochondrium, intolerance to certain types of food, and often they
detected by chance on ultrasound.

Polyps treatment

Opinion of most experts in the detection of polyps in
gall – surgery, that is, only surgery,
100% of the indications for which is:

  • Polyp, with a size of less than 10 mm on the leg control every
    half a year for 2 years and once a year for life, with its growth –
    показано deletion. However, some doctors insist on
    the need for surgery immediately after the discovery of a large
    neoplasms.
  • With развитии клинических симптомов полипов — deletion показано
    regardless of their size and appearance.
  • Any polyps over 10 mm are recommended to be removed due to high
    the risk of its transformation into cancer.

Given the oncological tensions, there is such
management of doubtful clinical cases – it is based
on constant control over the size of even small polyps. If he
less than 1 mm – there is no indication for removal, but most doctors
insist on a monthly ultrasound control for 6 months, then
every 3 months, then six months and then annually. Remind you
rapid growth of a polyp is considered to be 2 mm per year.

Among modern methods of surgical intervention about
removal of a polyp or gallbladder are the following
methods:

  • LCE – Video laparoscopic cholecystectomy – modern
    endoscopic technologies, the most benign operations, but
    are performed only in certain cases (see laparoscopy
    gallbladder)
  • OLHA – open laparoscopic cholecystectomy, performed
    from the mini-access using the tools “Mini-
    assistant”
  •  Традиционная холецистэктомия, ТХЭ, производится из
    oblique or median laparotomy access
  • Endoscopic polypectomy – long-term results and
    the consequences of such an operation have not been studied deeply and so far
    not used often.

Reference:

  • The frequency of cancer of the gallbladder – 0,27-0,41% among all cancers
  • In women, it occurs 2 times more often than in men.
  • Among oncology of the gastrointestinal tract, gallbladder cancer takes the 5th place (after
    cancer of the stomach, pancreas, colon and rectum)
  • Среди онкологии органов гепато-панкреато-дуоденальной зоны
    – 2 place after pancreatic cancer
  • The risk of development increases after 45-50 years, the peak incidence
    56-70 years old
  • With операциях на желчевыводящих путях встречается в 1-5%
    cases.

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