Polyps in the gallbladder - types, symptoms and treatment methods. Professor Puchkov K.V.

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Among the pathologies of internal organs, gallbladder diseases are quite common. But some of them may remain undetected for a long time, despite the fact that the patient regularly attends preventive examinations. One of these pathologies is polyps in the gallbladder, which are not so easy to diagnose.

Puchkov K.V. in the TV show “Health” with Elena Malysheva"

Unlike other ailments, for example, a kink in the gallbladder, the presence of polyps does not cause specific symptoms. The symptoms of this pathology are vague; the signs accompanying this disease are often found in other diseases. Therefore, diagnosis is sometimes carried out by the method of exclusion. In this case, the patient is usually prescribed an ultrasound examination of the internal organs, if their functioning is disrupted, similar signs arise. For example, intestinal dysfunction occurs in most diseases of the digestive system. In addition, the reason for the low detection of polyps in the gallbladder can be attributed to the ineffectiveness of conventional examinations. Only a targeted examination, measured for gallbladder diseases, can be successful. However, for this the patient should undergo the necessary studies.

There are several types of polyps in the gallbladder:

• Inflammatory polyps appear as a result of an acute reaction of the organ mucosa to the proliferation of granulation tissue.
• Cholesterol - the mucous membrane of the bladder changes due to cholesterol deposits and accumulations; This type is the most common. Despite the fact that the presence of such plaques does not pose a danger, the need for urgent surgical treatment causes debate among doctors.
• Papilloma is a benign tumor, which is characterized by the presence of papillae on the mucosa.
• Gallbladder adenoma is a benign formation that appears as a result of the growth of glandular tissue.

Gallbladder polyp.

Gallbladder polyps If we talk about polyps in general, polyps are a collective concept that denotes pathological formations that are very different in origin and essence. The main thing is that these are benign growths on the mucous membrane. Polyps can be in any organ that has a mucous membrane, for example in the stomach, intestines, uterus, bladder. For example, to understand what polyps generally look like, you can look at intestinal polyps:

Gallbladder polyps are a fairly common occurrence. On average, 4-6% of the population have them. 80% of them are observed in women over 30 years of age. What types of gallbladder polyps are there? The most common types of polyps found in the gallbladder are four. Cholesterol polyp

- elevation of the gallbladder mucosa with cholesterol deposits.
Inflammatory polyp
is an inflammatory reaction of the mucous membrane of the gallbladder in the form of proliferation of granulation tissue.
Gallbladder adenoma
is a benign tumor in the form of a polyp-like growth of glandular tissue.
Gallbladder papilloma
is a benign tumor of the mucous membrane of the gallbladder in the form of papillary growths.
Why are gallbladder polyps dangerous? Gallbladder polyps themselves are not scary. The bad thing is that polyps can degenerate into malignant tumors, or cancer can be disguised as a polyp. Thus, almost all authors who have studied this problem report a fairly high percentage of malignant degeneration of polyps, even in asymptomatic cases. The percentage of such degeneration (malignancy) ranges from 10 to 33%. How do gallbladder polyps appear? There are no specific complaints in patients with gallbladder polyps. Often, polyps do not manifest themselves at all. There may be discomfort in the right hypochondrium and epigastrium, poor tolerance to any types of food. Almost always, a gallbladder polyp is an incidental finding during ultrasound examination. How is gallbladder polyps diagnosed? As with other diseases of the gallbladder, ultrasound plays a decisive role. In this case, a certain rounded formation is identified in the gallbladder, connected to the wall of the bladder, and not giving an acoustic shadow. An interesting and probably promising method for diagnosing gallbladder polyps is endoscopic ultrasonography. In this case, a long and flexible endoscope (similar to a gastroscope) has an ultrasonic sensor at the end. The patient swallows this device, then it is inserted into the duodenum, which, as is known, is closely adjacent to the gallbladder. Since it uses significantly higher ultrasound frequencies (from 7.5 to 12 megahertz compared to 2 - 5 megahertz in a standard study), endoscopic ultrasonography provides high-quality images of even small structures and allows one to distinguish the layers of the gallbladder wall. Treatment of gallbladder polyps One or another treatment option for a gallbladder polyp discovered in you depends on a number of factors. Moreover, indications for surgery can be identified by contacting the operating surgeon, and not other specialists. If we summarize the approaches proposed by various authors, when choosing treatment, we can focus on the following scheme. Polyps larger than 10 mm should be removed as they pose a significant risk of malignant transformation or are already cancerous. Growing polyps should be removed. To determine whether polyps are growing, an ultrasound examination should be done on the same machine and by the same specialist at an interval of 6 months. Then monitoring should be done once a year for life. If any of these follow-up studies reveal that the polyp is increasing in size, or there are changes in its blood supply, or other polyps are appearing, then one should be inclined to undergo surgery rather than live “on a powder keg” waiting for cancer. In the event that the polyp does not have a stalk (polyp on a wide base), monitoring should be done once every 3 months in the first year after its discovery with a mandatory study of blood flow characteristics, and then 2 times a year. This is due to the fact that such polyps are more prone to malignant degeneration than polyps that have a stalk. After 2-3 years, control studies are also carried out every year for life. If the polyp begins to grow, then surgery is indicated. Another indication for cholecystectomy for polyps is their location in the neck of the gallbladder. In this case, they can be the background and cause of the development of acute inflammation with disruption of the outflow of bile from the gallbladder. What is surgery for gallbladder polyps? The standard operation for gallbladder polyps currently is laparoscopic cholecystectomy, that is, removal of the gallbladder using endoscopic technology.

Causes of polyps

• Heredity and predisposition more often than other reasons lead to the formation of polyps. This may be due to the structure of the bladder mucosa - most often this is the so-called “launching pad” for the appearance of polyposis.
• Irregular and irrational nutrition, abuse of food containing cholesterol is also one of the unfavorable factors.
• Chronic cholecystitis, in which the flow of bile into the duodenum is impaired.

Despite the fact that adenoma and papilloma are benign formations, there is a possibility of their degeneration into malignant tumors. In addition, tumor particles entering outside the gallbladder can lead to the spread of polyps to other organs.

Who is at risk from polyps?

Polyps are most often found in middle-aged and elderly people. Their appearance is expected when infected with Helicobacter pylori, since this bacterium increases the risk of developing chronic gastritis, and gastritis is considered one of the causes of polyps.

Multiple polyps are five times more likely to cause malignancy than single polyps. There is a close relationship between the size of the polyp and the risk of malignant neoplasm - a formation with a diameter of 1.5 cm is repeated in malignant disease in 6.8% of cases, and with a diameter of 3 cm - in 73.7%. Polyps with flat stalks are three times more likely to become cancerous than polyps with long stalks.

Symptoms of the disease

Often the disease is asymptomatic. Half of the patients experience only a feeling of discomfort in the right hypochondrium. Some patients experience heartburn and belching, and sometimes pain may occur. Soreness is a common symptom in cases where the polyp is localized in the narrowest place of the gallbladder - in the neck. If large in size, it can lead to blockage of the duct, which will cause stagnation of bile. As a result, the digestion process is disrupted, leading to belching, pain in the right hypochondrium, constipation, etc.

Is the diet effective when there are polyps?

Since polyps are asymptomatic and do not react in any way to your lifestyle, a diet is not needed when they are detected. Sometimes, if polyps have been found recently, you can try to dissolve them - add the same analogues of natural solvents (ursodeoxycholic acid). But the success rate of such an intervention is very modest, so the patient often prefers not to take pills for months with an unknown result.

An important note: if you have symptoms - pain in the hypochondrium, nausea, other troubles - polyps discovered during examination are almost never the cause. So demand from your doctor a reasonable explanation of your ailments, do not blame everything on polyps.

Specialist consultation is required.

Treatment of polyposis

First of all, nutritional correction is necessary. As a result of the disease, the amount of incoming bile is insufficient for digestion. But with the help of diet you can ease the work of the gastrointestinal tract. Fractional balanced nutrition in small portions, easily digestible foods will help prevent the occurrence of digestive system dysfunction.

As a rule, the most effective way to get rid of polyps is surgery. However, the question of the advisability of surgical treatment is decided only individually. Therapeutic tactics are based on observation of the patient, taking into account the structure and number of polyps, the presence of a pedicle, etc. If there is a formation with a pedicle, it is recommended to conduct an ultrasound every six months; in the absence of a pedicle, control studies should be done more often.

Education mechanism

If a large amount of cholesterol enters the blood, its excess remains in the bile

If a large amount of cholesterol enters the blood, its excess remains in the bile. First, macrophages try to capture it - cells that rid the body of foreign particles and decay products. But they are not able to remove all the cholesterol, so the fat cells attach to the walls of the organ and begin to grow.

If treatment is not started, the polyps will reach large sizes. When a polyp breaks away from the wall, it becomes a cholesterol stone and is clearly visible on ultrasound.

Surgical treatment of polyposis

Report on the master class by Prof. Puchkova K.V.

The absolute indication for surgery is the large size of the formation and the pain experienced by the patient. In addition, you should know that polyps that do not have a stalk tend to degenerate into malignant carcinomas. They are characterized by rapid growth and progression, which poses a threat to the patient's health. In this case, immediate surgery is the only solution.

The scope of surgical intervention is discussed in each specific case individually. Indications for surgical intervention are polyps measuring 7 mm and above, as well as any size of polyp located in the neck of the gallbladder due to a sharp disruption of the function of the organ and the development of chronic cholecystitis.

Indications for cholecystectomy

Risk factors for which surgical treatment is indicated:

• age over 60-70 years,
• polyp size is more than 15-20 mm in diameter,
• single polyp and the presence of gallstones,
• negative dynamics during previous ultrasound – polyp growth by more than 2 mm per year,
• the presence of a polyp on a thin stalk.
• presence of pain syndrome.

The growth characteristics of polyps are important:

• no growth, growth of 1 mm per year is within the measurement error,
• slow growth - an increase in diameter of more than 2 mm per year,
• rapid growth - more than 2 mm during the year, requires consultation with a surgeon or oncologist.

Surgical methods for treating gallbladder polyps

Watch a video of operations performed by Professor K.V. Puchkov. You can visit the website “Video of operations of the best surgeons in the world.”

Today there are two main methods of surgical treatment of polyposis:

Puchkov K.V., Khubezov D.A., Puchkov D.K., Rodimov S.V. Minimally invasive laparoscopic methods for treating gallbladder diseases: a textbook for surgeons // Ryazan State Medical University of the Ministry of Health of Russia. - Ryazan: RIO RyazGMU, 2015. - 115 p.

Puchkov K.V., Puchkov D.K. SURGERY FOR GALLSTONES: laparoscopy, minilaparoscopy, single port, transanal access, simultaneous operations.-M.: ID "MEPRACTIKA-M", 2021, 312 p.

Patent. A method for temporary fixation of abdominal and pelvic organs during laparoscopic operations.

Laparoscopic gallbladder removal - single-port cholecystectomy

• Laparoscopic cholecystectomy - with this method, the intervention is performed using laparoscopic equipment through small incisions on the anterior wall of the peritoneum, through a puncture in the umbilical area or transvaginally. Today, laparoscopy is recognized as the “gold” standard in abdominal surgery. Among the advantages of this method, it is worth noting the excellent cosmetic result: only small incisions remain on the skin. The rehabilitation period is much shorter than with traditional surgical treatment. The patient begins to walk on the first day, and on the second day he is allowed to take liquid food. The operated patient usually leaves the clinic on the 2nd or 3rd day after the operation. A person can usually start work within 10-14 days.
• traditional cholecystectomy
  is an open operation, performed manually, with a 15-20 cm long incision made on the anterior abdominal wall. Currently, surgical intervention by this method is performed only for complications of gallbladder polyps - degeneration into cancer with metastases to regional lymph nodes.

These operations are performed under general anesthesia, and the gallbladder is removed along with the polyps. Unfortunately, there are currently no methods for removing polyps from the gallbladder.

Diagnostics

The diagnosis is made by a gastroenterologist. The following methods are used for diagnosis:

1. External examination and analysis of patient complaints. Polyps may be indicated by a yellow tint to the abdomen, bitter belching and pain in the right side.
2. General blood analysis. The patient exhibits leukocytosis and increased ESR.
3. Biochemistry of blood. The indicators of bilirubin and cholesterol are examined; they significantly exceed the permissible standards.
4. Ultrasound. Detects changes in the size and structure of the organ, visualizes the presence of polyps and stones. However, it is impossible to determine from ultrasound what type of polyps existing in the bladder are.
5. Ultrasonography. The patient swallows a tube with a sensor that examines the walls of the organ from the inside. This method allows you to get a clearer picture of what is happening.
6. Magnetic resonance cholangiography. The most informative study that allows you to detect the most minor changes in the organ.

Diet

Don't forget to drink enough plain water

Treatment of polyps is impossible without nutritional adjustments. Patients must also adhere to a diet after surgery. Basic principles of dietary nutrition:

1. Limiting animal fats.
2. Increasing the amount of plant foods.
3. Refusal of junk food (fast food, salty, smoked, spicy, fried foods).
4. Eating small portions 5-6 times a day.
5. Avoiding long breaks between meals.
6. Quitting alcohol and nicotine.
7. Drink up to 2 liters of still water per day.
8. Including fiber and bran in the menu.
9. A varied diet, balanced in vitamins and minerals.

Complications

Multiple polyps contribute to the degeneration of cells into malignant ones, then gallbladder cancer forms

Untreated cholesterol polyps can lead to serious complications. The most dangerous of them:

1. Cholesterol stones. This occurs when the polyp remains inside the organ for a long time and becomes calcified. The next contraction of the walls of the bladder contributes to the separation of the stem of the formation.
2. Blockage of ducts with stones. If a stone gets stuck in the bile duct, bile will not be able to leave the organ. This is fraught with rupture of the bladder walls, peritonitis and sepsis. Bilirubin accumulates in the patient's blood, as a result of which the skin turns yellow, that is, obstructive jaundice occurs. The patient requires urgent surgical intervention, without which he will die.
3. Getting stones stuck in the sphincter of Oddi prevents enzymes from flowing from the pancreas to the bile. Therefore, acute pancreatitis begins, turning into pancreatic necrosis.
4. Multiple polyps contribute to the degeneration of cells into malignant ones, then gallbladder cancer is formed.