Полипы желчного пузыря: современные подходы к диагностике и лечению
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Onuchina E.V. Gallbladder polyps: modern approaches to diagnostics and treatment. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (1): 100–107. DOI: 10.26442/00403660.2021.01.200544
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В обзоре современной литературы представлены когортные и рандомизированные контролируемые исследования, в том числе обобщенные в метаанализах и систематических обзорах, свидетельствующие о том, что доминирующей формой полиповидных образований желчного пузыря являются холестериновые псевдополипы, не имеющие злокачественного потенциала, ассоциированные с нарушением метаболизма холестерина, часто сочетающиеся с холестерозом желчного пузыря, метаболическим синдромом и сердечно-сосудистой заболеваемостью. Накапливаются доказательства эффективности урсодезоксихолевой кислоты для контроля компонентов метаболического синдрома и сердечно-сосудистых рисков. Препараты урсодезоксихолевой кислоты могут стать перспективными для ведения холестериновых полипов.
Ключевые слова: полипы желчного пузыря, холестериновые полипы желчного пузыря, метаболический синдром, сердечно-сосудистые риски, урсодезоксихолевая кислота
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Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, "benign" tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.
Keywords: gallbladder polyps, cholesterol polyps of the gallbladder, metabolic syndrome, cardiovascular risks, ursodeoxycholic acid
2. McCain RS, Diamond A, Jones C, Coleman HG. Current practices and future prospects for the management of gallbladder polyps: A topical review. World J Gastroenterol. 2018;24(26):2844-52. doi: 10.3748/wjg.v24.i26.2844
3. Wennmacker SZ, Lamberts MP, Di Martino M, et al. Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev. 2018;8(8):CD012233. Published 2018 Aug 15. doi: 10.1002/14651858.CD012233.pub2
4. Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg. 2018;61(3):200-7. doi: 10.1503/cjs.011617
5. Gurusamy KS, Abu-Amara M, Farouk M, Davidson BR. Cholecystectomy for gallbladder polyp. Cochrane Database Syst Rev. 2009;1:CD007052. Published 2009 Jan 21. doi: 10.1002/14651858.CD007052.pub2
6. Bhatt NR, Gillis A, Smoothey CO, et al. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon. 2016;14(5):278-86. doi: 10.1016/j.surge.2015.12.001
7. Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbecks Arch Surg. 2015;400(4):455-62. doi: 10.1007/s00423-015-1302-2
8. Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol. 1970;90(5):423-32.
9. Dilek ON, Karasu S, Dilek FH. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol. 2019;9(1):40-8. doi: 10.5005/jp-journals-10018-1294
10. Lee H, Kim K, Park I, et al. Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder. Ann Hepatobiliary Pancreat Surg. 2016;20(4):180-6. doi: 10.14701/ahbps.2016.20.4.180
11. Taskin OC, Bellolio E, Dursun N, et al. Non-neoplastic Polyps of the Gallbladder: A Clinicopathologic Analysis of 447 Cases. Am J Surg Pathol. 2020;44(4):467-76. doi: 10.1097/PAS.0000000000001405
12. Kocaöz S, Turan G. Preneoplastic and neoplastic gallbladder lesions detected after cholecystectomy. Prz Gastroenterol. 2019;14(3):193-7. doi: 10.5114/pg.2019.82675
13. Sun Y, Yang Z, Lan X, Tan H. Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps. Hepatobiliary Surg Nutr. 2019;8(3):219-27. doi: 10.21037/hbsn.2018.12.15
14. Guo J, Wu G, Zhou Z. Polypoid lesions of the gallbladder: report of 160 cases with special reference to diagnosis and treatment in China. Int J Clin Exp Pathol. 2015;8(9):11569-78. Published 2015 Sep 1.
15. Kwon W, Jang JY, Lee SE, et al. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci. 2009;24(3):481-7. doi: 10.3346/jkms.2009.24.3.481
16. Pickering O, Pucher PH, Toale C, et al. Prevalence and Sonographic Detection of Gallbladder Polyps in a Western European Population.
J Surg Res. 2020;250:226-31. doi: 10.1016/j.jss.2020.01.003
17. Wennmacker SZ, van Dijk AH, Raessens JHJ, et al. Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc. 2019;33(5):1564-71. doi: 10.1007/s00464-018-6444-1
18. Yamin Z, Xuesong B, Guibin Y, et al. Risk factors of gallbladder polyps formation in East Asian population: A meta-analysis and systematic review. Asian J Surg. 2020;43(1):52-9. doi: 10.1016/j.asjsur.2019.03.015
19. Akyürek N, Salman B, Irkörücü O, et al. Ultrasonography in the diagnosis of true gallbladder polyps: the contradiction in the literature. HPB (Oxford). 2005;7(2):155-8. doi: 10.1080/13651820510003762
20. Şahiner İT, Dolapçı M. When should gallbladder polyps be treated surgically? Adv Clin Exp Med. 2018;27(12):1697-700. doi: 10.17219/acem/75678
21. Wu CH, Luo Y, Fei X, et al. Algorithmic approaches to the diagnosis of gallbladder intraluminal lesions on ultrasonography. J Chin Med Assoc. 2018;1(4):297-304. doi: 10.1016/j.jcma.2018.01.002
22. Okaniwa S. Role of conventional ultrasonography in the diagnosis of gallbladder polypoid lesions [published online ahead of print, 2019 Dec 11]. J Med Ultrason (2001). 2019;10.1007/s10396-019-00989-5. doi: 10.1007/s10396-019-00989-5
23. Smereczyński A, Kołaczyk K, Bernatowicz E. Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature. J Ultrason. 2020;20(80):e29-e35. doi: 10.15557/JoU.2020.0006
24. Jang JY, Kim SW, Lee SE, et al. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg. 2009;250(6):943-9. doi: 10.1097/SLA.0b013e3181b5d5fc
25. Miwa H, Numata K, Sugimori K, et al. Vascular evaluation using transabdominal ultrasound for gallbladder polyps [published online ahead of print, 2020 Mar 3]. J Med Ultrason (2001). 2020;10.1007/s10396-020-01008-8. doi: 10.1007/s10396-020-01008-8
26. Yin SN, Chi J, Liu L, et al. Dual-energy CT to differentiate gallbladder polyps: cholesterol versus adenomatous [published online ahead of print, 2020 Apr 15]. Acta Radiol. 2020;284185120916202. doi: 10.1177/0284185120916202
27. Yang X, Liu Y, Guo Y, et al. Utility of radiomics based on contrast-enhanced CT and clinical data in the differentiation of benign and malignant gallbladder polypoid lesions [published online ahead of print, 2020 Mar 12]. Abdom Radiol (NY). 2020;10.1007/s00261-020-02461-2. doi: 10.1007/s00261-020-02461-2
28. Csendes A, Burgos AM, Csendes P, et al. Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Ann Surg. 2001;234(5):657-60. doi: 10.1097/00000658-200111000-00011
29. Kratzer W, Haenle MM, Voegtle A, et al. Ultrasonographically detected gallbladder polyps: a reason for concern? A seven-year follow-up study. BMC Gastroenterol. 2008;8:41. Published 2008 Sep 15. doi: 10.1186/1471-230X-8-41
30. Heitz L, Kratzer W, Gräter T, Schmidberger J; EMIL study group. Gallbladder polyps – a follow-up study after 11 years. BMC Gastroenterol. 2019;19(1):42. Published 2019 Mar 18. doi: 10.1186/s12876-019-0959-3
31. Park JY, Hong SP, Kim YJ, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol. 2009;24(2):219-22. doi: 10.1111/j.1440-1746.2008.05689.x
32. Choi YS, Do JH, Seo SW, et аl. Prevalence and Risk Factors of Gallbladder Polypoid Lesions in a Healthy Population. Yonsei Med J. 2016;57(6):1370-5. doi: 10.3349/ymj.2016.57.6.1370
33. Lim SH, Kim DH, Park MJ, et al. Is Metabolic Syndrome One of the Risk Factors for Gallbladder Polyps Found by Ultrasonography during Health Screening? Gut Liver. 2007;1(2):138-44. doi: 10.5009/gnl.2007.1.2.138
34. Lee JK, Hahn SJ, Kang HW, et al. Visceral Obesity Is Associated with Gallbladder Polyps. Gut Liver. 2016;10(1):133-9. doi: 10.5009/gnl14506
35. Yamin Z, Xuesong B, Zhen Z, et al. Correlation of dyslipidemias
and gallbladder polyps-A large retrospective study among Chinese population. Asian J Surg. 2020;43(1):181-5. doi: 10.1016/j.asjsur.2019.01.013
36. Chen CH, Lin CL, Kao CH. The risk of coronary heart disease after diagnosis of gallbladder polyp: a retrospective nationwide population-based cohort study. Ann Transl Med. 2019;7(23):753. doi: 10.21037/atm.2019.11.114
37. Chen CH, Lin CL, Kao CH. Association of Gallbladder Polyp and Stroke: A Nationwide, Population-Based Study. Medicine (Baltimore). 2015;94(48):e2192. doi: 10.1097/MD.0000000000002192
38. Zhao M-F, Huang P, Ge CL, et al. Conjugated bile acids in gallbladder bile and serum as potential biomarkers for cholesterol polyps and adenomatous polyps. Int J Biol Markers. 2016;31(1):e73-e79. Published 2016 Feb 28. doi: 10.5301/jbm.5000173
39. Simental-Mendía LE, Simental-Mendía M, Sánchez-García A, et al. Impact of ursodeoxycholic acid on circulating lipid concentrations: a systematic review and meta-analysis of randomized placebo-controlled trials. Lipids Health Dis. 2019;18(1):88. Published 2019 Apr 6. doi: 10.1186/s12944-019-1041-4
40. Sánchez-García A, Sahebkar A, Simental-Mendía M, Simental-Mendía LE. Effect of ursodeoxycholic acid on glycemic markers:
A systematic review and meta-analysis of clinical trials. Pharmacol Res. 2018;135:144-9. doi: 10.1016/j.phrs.2018.08.008
41. Ильченко А.А., Дрожжина Ю.В. Эффективность урсотерапии при холестеринассоциированной патологии желчного пузыря. Экспериментальная и клиническая гастроэнтерология. 2009;8:96-101 [Il'chenko AA, Drozhzhina IuV. Efficiency of Ursotherapy in Cholesterol-Associated Pathology of the Gallbladder. Eksp Klin Gastroenterol. 2009;8:96-101 (In Russ.)].
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1. Wiles R, Thoeni RF, Barbu ST, et al. A Management and follow-up of gallbladder polyps: Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 2017;27(9):3856-66. doi: 10.1007/s00330-017-4742-y
2. McCain RS, Diamond A, Jones C, Coleman HG. Current practices and future prospects for the management of gallbladder polyps: A topical review. World J Gastroenterol. 2018;24(26):2844-52. doi: 10.3748/wjg.v24.i26.2844
3. Wennmacker SZ, Lamberts MP, Di Martino M, et al. Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev. 2018;8(8):CD012233. Published 2018 Aug 15. doi: 10.1002/14651858.CD012233.pub2
4. Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg. 2018;61(3):200-7. doi: 10.1503/cjs.011617
5. Gurusamy KS, Abu-Amara M, Farouk M, Davidson BR. Cholecystectomy for gallbladder polyp. Cochrane Database Syst Rev. 2009;1:CD007052. Published 2009 Jan 21. doi: 10.1002/14651858.CD007052.pub2
6. Bhatt NR, Gillis A, Smoothey CO, et al. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon. 2016;14(5):278-86. doi: 10.1016/j.surge.2015.12.001
7. Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbecks Arch Surg. 2015;400(4):455-62. doi: 10.1007/s00423-015-1302-2
8. Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol. 1970;90(5):423-32.
9. Dilek ON, Karasu S, Dilek FH. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol. 2019;9(1):40-8. doi: 10.5005/jp-journals-10018-1294
10. Lee H, Kim K, Park I, et al. Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder. Ann Hepatobiliary Pancreat Surg. 2016;20(4):180-6. doi: 10.14701/ahbps.2016.20.4.180
11. Taskin OC, Bellolio E, Dursun N, et al. Non-neoplastic Polyps of the Gallbladder: A Clinicopathologic Analysis of 447 Cases. Am J Surg Pathol. 2020;44(4):467-76. doi: 10.1097/PAS.0000000000001405
12. Kocaöz S, Turan G. Preneoplastic and neoplastic gallbladder lesions detected after cholecystectomy. Prz Gastroenterol. 2019;14(3):193-7. doi: 10.5114/pg.2019.82675
13. Sun Y, Yang Z, Lan X, Tan H. Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps. Hepatobiliary Surg Nutr. 2019;8(3):219-27. doi: 10.21037/hbsn.2018.12.15
14. Guo J, Wu G, Zhou Z. Polypoid lesions of the gallbladder: report of 160 cases with special reference to diagnosis and treatment in China. Int J Clin Exp Pathol. 2015;8(9):11569-78. Published 2015 Sep 1.
15. Kwon W, Jang JY, Lee SE, et al. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci. 2009;24(3):481-7. doi: 10.3346/jkms.2009.24.3.481
16. Pickering O, Pucher PH, Toale C, et al. Prevalence and Sonographic Detection of Gallbladder Polyps in a Western European Population.
J Surg Res. 2020;250:226-31. doi: 10.1016/j.jss.2020.01.003
17. Wennmacker SZ, van Dijk AH, Raessens JHJ, et al. Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc. 2019;33(5):1564-71. doi: 10.1007/s00464-018-6444-1
18. Yamin Z, Xuesong B, Guibin Y, et al. Risk factors of gallbladder polyps formation in East Asian population: A meta-analysis and systematic review. Asian J Surg. 2020;43(1):52-9. doi: 10.1016/j.asjsur.2019.03.015
19. Akyürek N, Salman B, Irkörücü O, et al. Ultrasonography in the diagnosis of true gallbladder polyps: the contradiction in the literature. HPB (Oxford). 2005;7(2):155-8. doi: 10.1080/13651820510003762
20. Şahiner İT, Dolapçı M. When should gallbladder polyps be treated surgically? Adv Clin Exp Med. 2018;27(12):1697-700. doi: 10.17219/acem/75678
21. Wu CH, Luo Y, Fei X, et al. Algorithmic approaches to the diagnosis of gallbladder intraluminal lesions on ultrasonography. J Chin Med Assoc. 2018;1(4):297-304. doi: 10.1016/j.jcma.2018.01.002
22. Okaniwa S. Role of conventional ultrasonography in the diagnosis of gallbladder polypoid lesions [published online ahead of print, 2019 Dec 11]. J Med Ultrason (2001). 2019;10.1007/s10396-019-00989-5. doi: 10.1007/s10396-019-00989-5
23. Smereczyński A, Kołaczyk K, Bernatowicz E. Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature. J Ultrason. 2020;20(80):e29-e35. doi: 10.15557/JoU.2020.0006
24. Jang JY, Kim SW, Lee SE, et al. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg. 2009;250(6):943-9. doi: 10.1097/SLA.0b013e3181b5d5fc
25. Miwa H, Numata K, Sugimori K, et al. Vascular evaluation using transabdominal ultrasound for gallbladder polyps [published online ahead of print, 2020 Mar 3]. J Med Ultrason (2001). 2020;10.1007/s10396-020-01008-8. doi: 10.1007/s10396-020-01008-8
26. Yin SN, Chi J, Liu L, et al. Dual-energy CT to differentiate gallbladder polyps: cholesterol versus adenomatous [published online ahead of print, 2020 Apr 15]. Acta Radiol. 2020;284185120916202. doi: 10.1177/0284185120916202
27. Yang X, Liu Y, Guo Y, et al. Utility of radiomics based on contrast-enhanced CT and clinical data in the differentiation of benign and malignant gallbladder polypoid lesions [published online ahead of print, 2020 Mar 12]. Abdom Radiol (NY). 2020;10.1007/s00261-020-02461-2. doi: 10.1007/s00261-020-02461-2
28. Csendes A, Burgos AM, Csendes P, et al. Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Ann Surg. 2001;234(5):657-60. doi: 10.1097/00000658-200111000-00011
29. Kratzer W, Haenle MM, Voegtle A, et al. Ultrasonographically detected gallbladder polyps: a reason for concern? A seven-year follow-up study. BMC Gastroenterol. 2008;8:41. Published 2008 Sep 15. doi: 10.1186/1471-230X-8-41
30. Heitz L, Kratzer W, Gräter T, Schmidberger J; EMIL study group. Gallbladder polyps – a follow-up study after 11 years. BMC Gastroenterol. 2019;19(1):42. Published 2019 Mar 18. doi: 10.1186/s12876-019-0959-3
31. Park JY, Hong SP, Kim YJ, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol. 2009;24(2):219-22. doi: 10.1111/j.1440-1746.2008.05689.x
32. Choi YS, Do JH, Seo SW, et аl. Prevalence and Risk Factors of Gallbladder Polypoid Lesions in a Healthy Population. Yonsei Med J. 2016;57(6):1370-5. doi: 10.3349/ymj.2016.57.6.1370
33. Lim SH, Kim DH, Park MJ, et al. Is Metabolic Syndrome One of the Risk Factors for Gallbladder Polyps Found by Ultrasonography during Health Screening? Gut Liver. 2007;1(2):138-44. doi: 10.5009/gnl.2007.1.2.138
34. Lee JK, Hahn SJ, Kang HW, et al. Visceral Obesity Is Associated with Gallbladder Polyps. Gut Liver. 2016;10(1):133-9. doi: 10.5009/gnl14506
35. Yamin Z, Xuesong B, Zhen Z, et al. Correlation of dyslipidemias
and gallbladder polyps-A large retrospective study among Chinese population. Asian J Surg. 2020;43(1):181-5. doi: 10.1016/j.asjsur.2019.01.013
36. Chen CH, Lin CL, Kao CH. The risk of coronary heart disease after diagnosis of gallbladder polyp: a retrospective nationwide population-based cohort study. Ann Transl Med. 2019;7(23):753. doi: 10.21037/atm.2019.11.114
37. Chen CH, Lin CL, Kao CH. Association of Gallbladder Polyp and Stroke: A Nationwide, Population-Based Study. Medicine (Baltimore). 2015;94(48):e2192. doi: 10.1097/MD.0000000000002192
38. Zhao M-F, Huang P, Ge CL, et al. Conjugated bile acids in gallbladder bile and serum as potential biomarkers for cholesterol polyps and adenomatous polyps. Int J Biol Markers. 2016;31(1):e73-e79. Published 2016 Feb 28. doi: 10.5301/jbm.5000173
39. Simental-Mendía LE, Simental-Mendía M, Sánchez-García A, et al. Impact of ursodeoxycholic acid on circulating lipid concentrations: a systematic review and meta-analysis of randomized placebo-controlled trials. Lipids Health Dis. 2019;18(1):88. Published 2019 Apr 6. doi: 10.1186/s12944-019-1041-4
40. Sánchez-García A, Sahebkar A, Simental-Mendía M, Simental-Mendía LE. Effect of ursodeoxycholic acid on glycemic markers:
A systematic review and meta-analysis of clinical trials. Pharmacol Res. 2018;135:144-9. doi: 10.1016/j.phrs.2018.08.008
41. Il'chenko AA, Drozhzhina IuV. Efficiency of Ursotherapy in Cholesterol-Associated Pathology of the Gallbladder. Eksp Klin Gastroenterol. 2009;8:96-101 (In Russ.)
Иркутская государственная академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Иркутск, Россия
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E.V. Onuchina
Irkutsk State Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education,
Irkutsk, Russia