Stringer et al developed an algorithmic approach to management of a pediatric patient with a polyp in the gallbladder. The authors are from St. James's University Hospital in Leeds, England.
Patient selection: pediatric patient with a polyp in the gallbladder, confirmed by repeat analysis
Parameters:
(1) type of gallbladder polyp
(2) biliary symptoms
(3) size in cm
Type |
Biliary Symptoms |
Size in cm |
Management |
pancreatobiliary malunion (PBM) |
NA |
NA |
radical excision and hepaticojejunostomy |
Peutz-Jeghers |
NA |
NA |
choledochal dilatation and cholecystectomy |
possibly malignant |
NA |
NA |
open cholecystectomy |
other |
present |
NA |
laparoscopic cholecystectomy |
other |
absent |
< 1 cm |
laparoscopic cholecystectomy |
other |
absent |
>= 1 cm |
monitor with ultrasound |
where:
• Metachromatic leukodystrophy, PBM and Peutz-Jeghers syndrome were classified as secondary polyps, while all other types are considered primary.
• The appropriate management of metachromatic leukodystrophy was not mentioned. Biliary symptoms are rare in this condition (page 1683), so management may target the underlying lysosomal storage disease.
Specialty: Gastroenterology, Surgery, general