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Enter the polyp's size and shape, what earlier scans showed, and the risk factors the guideline names, and read the recommendation that applies, quoted word for word from the 2022 joint guideline of the European radiology, endoscopic surgery, digestive surgery and endoscopy societies. An educational aid to prepare for the conversation with your surgeon, not advice. Nothing you enter leaves this page.
Answer the 7 questions and the statement that applies to that combination appears here, quoted word for word from Foley et al., Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE, European Radiology 2022 and the sources listed below, with a plain line on what it means and the questions to take to your surgeon.
Without JavaScript, every statement the aid can show is listed further down the page. This is an educational aid, not advice.
The aid picks from these 9 cards; each quotes its source word for word. Read them all here, with or without the questions above.
“If during follow-up the gallbladder polypoid lesion disappears, then monitoring can be discontinued.”
What this means: The guideline treats a polyp that has vanished on ultrasound as one that no longer needs watching; the authors note that ultrasound misses few real polyps, so a disappearance is trusted.
“Cholecystectomy is recommended in patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery. Multidisciplinary discussion may be employed to assess perceived individual risk of malignancy.”
What this means: At this size the guideline recommends removing the gallbladder, for anyone fit enough for the operation who wants it. The recommendation rests on low-quality evidence: the authors record that half of polyps in one national pathology series were 10 mm or larger and that the threshold sorts neoplastic from harmless polyps only moderately well.
“If during follow-up the gallbladder polypoid lesion reaches 10 mm, then cholecystectomy is advised.”
What this means: Growth to 10 mm ends the watching period; the guideline's own evidence review adds that in the largest cohort, growth to 10 mm was not itself associated with a higher cancer rate, which is why this statement carries a moderate rather than strong grade.
“If the patient has a 6–9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery. These risk factors are: Age more than 60 years; History of primary sclerosing cholangitis (PSC); Asian ethnicity; Sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm).”
What this means: A mid-sized polyp plus any one of the four named factors puts you in the group the guideline says should be offered the operation. The factors are the guideline's, not OnCo's: the authors raised the age threshold to 60 on a 2016 systematic review and widened the ethnicity factor from Indian to Asian populations on a 2020 review.
“If the patient has either: No risk factors for malignancy and a gallbladder polypoid lesion of 6–9 mm or Risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less. Follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year and 2 years. Follow-up should be discontinued after 2 years in the absence of growth.”
What this means: Three scans over two years, then stop if nothing has grown. The guideline adds that monitoring is meant for people who would be fit for surgery if the polyp changed.
“If the patient has no risk factors for malignancy, and a gallbladder polypoid lesion of 5 mm or less, follow-up is not required.”
What this means: The guideline says a tiny polyp with none of the four risk factors can be left alone. Its evidence review cites a cohort of more than 600,000 people in which the cancer rate was no higher in those with a polyp on the first scan than in those without, and estimates that tens of thousands of scans would be needed to find one cancer in this group.
“If the polypoid lesion grows by 2 mm or more within the 2-year follow-up period, then the current size of the polypoid lesion should be considered along with patient risk factors. Multidisciplinary discussion may be employed to decide whether continuation of monitoring, or cholecystectomy, is necessary.”
What this means: Growth of 2 mm does not by itself decide anything: the guideline asks the team to look at the polyp's present size and your risk factors, which is what the card below does, and allows a multidisciplinary meeting to settle it. Its evidence review notes that slow growth is part of the natural history of these polyps.
“Cholecystectomy is suggested if no alternative cause for the patient’s symptoms is demonstrated and the patient is fit for, and accepts, surgery. The patient should be counselled about the benefit of cholecystectomy versus the risk of persistent symptoms.”
What this means: When pain or other symptoms seem to come from the gallbladder and nothing else explains them, the guideline suggests the operation whatever the polyp's size, with a warning: in one series cited, six in ten people still had pain afterwards. The polyp itself is unlikely to be the cause of pain.
“Primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound. Routine use of other imaging modalities is not recommended presently, but further research is needed. In centres with appropriate expertise and resources, alternative imaging modalities (such as contrast-enhanced and endoscopic ultrasound) may be useful to aid decision-making in difficult cases.”
What this means: The rules above are written for ordinary abdominal ultrasound. Where several polyps are present, the guideline says the largest is measured and decides management; contrast or endoscopic ultrasound is for expert centres in difficult cases.
Each combination of answers maps to a fixed set of cards, and every card quotes the statement it implements with the page it was read from; nothing is scored or inferred. Where the sources disagree, both are quoted. The mapping is data in the OnCo repository and is tested against every combination of answers. Checked 2026-09-24.
This is an educational aid to prepare for a conversation with your surgical team. It is not medical advice, and it cannot see your scans or your history. OnCo is orientation, not medical advice.