Gallbladder polyps may not require surveillance

  • Szpakowski JL & al.
  • JAMA Netw Open
  • 1 May 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A retrospective analysis of subjects with gallbladder polyps (GPs) finds an incidence of gallbladder cancer (GBC) no different than subjects without GPs.

Why this matters

  • The study suggests a need to revise guidelines that suggest following up GPs to prevent GBC, which were based on low levels of evidence.

Study design

  • Retrospective observational cohort study drawn from Kaiser Permanente Northern California (n=622,227), including 35,856 with GPs (52% women; 43% Black/Hispanic/Asian; median age, 50 years).
  • Funding: Kaiser Permanente Northern California.

Key results

  • 71.1% had a quantitative size assessment, 68.8% had a GP
  • 19 of 35,856 were diagnosed with GBC (11.3 [95% CI, 6.2-16.3] per 100,000 person-years).
  • The rate of GBC increased with initial polyp size:
    • 6 to
    • ≥10 mm (128.2 [95% CI, 39.4-217.0] per 100,000 person-years).
  • The unadjusted crude proportion of GBC with any GP was 0.053%, compared with 0.054% for adults with no GP (P=.94).
  • After the first year, only 6 cases of GBC were diagnosed (3.6 [95% CI, 0.7-6.5] per 100,000 person-years).

Limitations

  • Retrospective.