GALLBLADDER POLYPS AND TREATMENT. Safrakesesi polipleri ve tedavisi.

ABSTRACT Gallbladder polyps are much less common than gallstones, and they are usually discovered as an incidental finding when an ultrasound of the abdomen is performed. The lifetime prevalence of gallbladder polyps ranges from 1% to 4%. Five types of polyps are found in the gallbladder. Cholesterol polyps account for 60% of all gallbladder polyps; they are usually multiple and pedunculated and range in size from 2-10 mm. These polyps occur as part of focal or generalized cholesterolosis of the gallbladder. Adenomyomas represent the second most common type of gallbladder polyp. These account for 25% of gallbladder polypoid lesions and are usually solitary, ranging in size from 10-20 mm on average and are nonneoplastic. Inflammatory polyps are the third most common type, accounting for 10% of all gallbladder polyps. These polyps consist of granulation tissue and fibrous tissue mixed with chronic inflammatory cells. They are generally solitary, and range in size from 5-10 mm. Totally, these 3 types of benign focal gallbladder lesions account for 95% of all gallbladder polyps and are not neoplasms. Adenomas account for 4% of gallbladder polyps are potentially premalignant. All adenomas usually contain cancer are > 12-15 mm in size. Gallbladder cancer occurs in approximately a 1/4 ratio. Miscellaneous polyps are rare lesions and include heterotopic gastric glands, carcinoid tumors, leiomyomas, fibromas, and neurofibromas. Management is usually guided by the characteristics of gallbladder polyps found on ultrasound, and abdominal tomography. Patients who are at high risk for surgery should have an ultrasound performed at 6-month intervals. The best treatment for gallbladder polyps is to surgically remove the gallbladder when polyps >/= 10 mm are present. Endoscopic ultrasound may become the standard of management in the future. OZET Safrakesesi polipleri yapilan karin USG incelemeleri sirasinda genellikle rastlantisal olarak saptanan lezyonlardir. Toplumda hayat boyu rastlanma sikligi %1-4‘dur. Bes degisik tipte polip vardir. Kolesterol polipleri butun vakalarin %60’ini olusturur. Genellikle multipl, sapli ve 2-20 mm captadirlar. Genellikle fokal veya yaygin kolesterolozisin bir sonucu olarak ortaya cikarlar ve kanserlesmezler. Adenomiyomlar ikinci en sik karsilasilan polipler olup, vakalarin %25’ini olustururlar. Siklikla soliter ve 10-20 mm buyukluge ulasirlar ve kanserlesmezler. Ucuncu siklikta gorulen, inflamasyondan sorumlu hucreler, granulasyon ve fibroz doku karisimindan olusan inflamatuar polipler vakalarin %10’unu olustururlar. Genellikle soliter ve 5-10 mm capli lezyonlardir. Bu uc grup polip butun poliplerin %95’ini olusturur ve kanserlesme riski yoktur. Adenomlar ise safra kesesi poliplerinin %4’unu olustururlar ve premalign lezyonlardir. Adenomlarin yaklasik 1/4'u kanserlesir ve capi 12 mm’yi gecen butun adenomlar kanser hucresi tasirlar. Mide heterotopik dokusu, karsinoid, leiomyom, fibrom ve norofibrom kaynakli polipler ise cok nadir gorulurler. Poliplerin tani, tedavi ve takibinde oncelikle ultrasonografi ve karin tomografisi faydalidir. Riskli oldugu dusunulen vakalarda 6 aylik aralarla ultrasonografi tekrarlanmalidir. Gunumuzde en cok uygulanan yaklasim capi 10 mm'yi gecen poliplerde laparoskopik kolesistektomi yapilmasiri. Endoskopik ultrasonografi yakin gelecekte tani ve tedavinin belirlenmesinde en onemli arac olacak gibi gozukmektedir.