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.
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