Gallbladder Polyps: Are We Still Over-Operating Despite New Guidelines? UEG Journal | July 2026

Introduction

Gallbladder polyps are commonly detected incidentally, with a prevalence of up to 7% in adults. The vast majority are benign, while only a small fraction represent adenomas with malignant potential. Because imaging cannot reliably distinguish benign from premalignant lesions, clinical guidelines have traditionally recommended surveillance or cholecystectomy based on size and risk factors. Updated European guidelines in 2022 aimed to reduce unnecessary surgery, but their real-world impact remains uncertain.

Problem Statement

Revised guidelines for gallbladder polyps have not effectively reduced unnecessary cholecystectomies for benign lesions.

Summary

The POLYP study demonstrates that despite updated 2022 European guidelines, a significant proportion of patients continue to undergo unnecessary surgery and follow-up. Among patients undergoing cholecystectomy, only 9% had true adenomas, while nearly 70% had non-neoplastic polyps, and many had no significant pathology.

Importantly, the revision of guidelines—mainly adjusting age criteria from 50 to 60 years—resulted in only a minimal reduction in surgeries. This suggests that current decision-making strategies remain insufficient to accurately identify patients who truly benefit from cholecystectomy.

Clinically, this study highlights a persistent gap between guidelines and optimal care. It underscores the need for better risk stratification tools, potentially incorporating advanced imaging, biomarkers, or predictive models, to avoid overtreatment.

The key takeaway is clear: most gallbladder polyps are benign, yet many patients still undergo unnecessary surgery—guidelines alone are not enough.