GI Endoscopy · 7 min read
Gallbladder Polyps: 10 mm or Risk Plus 6-9 mm Goes to Cholecystectomy
Most 'polyps' are cholesterol. Size plus four risk factors decide surgery. The fundal fold lives on the other Phrygian URL.
Clinical Bottom Line
| Lesion | Foley 2022 action |
|---|---|
| 10 mm or more | Cholecystectomy if the patient is fit and accepts surgery. MDT when comorbidity makes the risk less obvious (PMID 34918177). |
| 6-9 mm plus a risk factor | Cholecystectomy. Risk factors: age over 60, PSC, Asian ethnicity, sessile (including focal wall thickening over 4 mm). |
| 6-9 mm, no risk factor | Ultrasound at 6 months, 1 year, and 2 years. Stop if no growth. Growth of 2 mm or more: use the new size plus risk factors; MDT. Reaching 10 mm: operate. |
| 5 mm or less, no risk factor | No follow-up. Most of these are cholesterol polyps. |
| 5 mm or less plus a risk factor | Same 6-month / 1-year / 2-year ultrasound schedule, then stop if stable. PSC still leans toward surgery even when small. |
Is this the Phrygian cap page?
No. The slug is leftover WordPress. The body has always been polyps. The congenital fundal fold is the symptoms URL. Do not cholecystectomize a Phrygian cap because this page said 10 mm.
Cholesterol polyps and adenomyomatosis are the usual findings. True adenomas exist and are why size still matters. Ultrasound is the first test (Foley rec 1). Contrast US or EUS is for hard cases at centers that do them, not a reflex second scan on every 4 mm lesion. The leftover table on this URL stopped 6-9 mm surveillance after one year and used age over 50 plus Indian ethnicity. Foley 2022 changed those: age over 60, Asian ethnicity, and a 2-year watch that then ends.
What if it grows 2 mm?
Not an automatic trip to the OR. Foley: take the new size and the risk factors back to the algorithm, with MDT if needed. Hitting 10 mm is the hard operate line. Symptoms that are truly biliary, with no other explanation, can justify cholecystectomy even when the polyp is smaller; counsel that the pain may stay. This page does not restage stones, ERCP, or Couinaud.
Selected references
- Foley KG, et al. Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol. 2022;32:3358-3368.
- Wiles R, et al. Management and follow-up of gallbladder polyps: joint guidelines. Eur Radiol. 2017;27:3856-3866.
Last reviewed September 20, 2026. Written for clinicians staring at a 7 mm gallbladder polyp on an ultrasound done for unrelated pain and deciding whether to operate or watch.
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