Heterogeneity in current guidelines for the management of gallbladder polyps ‒ A systematic review

Gallbladder polyps are elevated lesions of the gallbladder mucosa that protrude into its lumen. Their prevalence in the general population ranges from 0.3% to 9.5%. Guidelines regarding surgical indications and follow-up remain controversial due to regional differences in the development of malignancy. Hence, this systematic review was performed to assess the heterogeneity in current international guidelines for the management of gallbladder polyps.

In accordance with the PRISMA guidelines, a comprehensive search of the literature was conducted from PubMed and Google Scholar (from January 2020 to April 2026; in Spanish and English) for official clinical practice guidelines and updated consensus statements issued by scientific societies. The methodological quality of the included studies was evaluated using the AGREE II instrument.

A total of five guidelines were included in the review. The divergent aspects evaluated were: the size threshold for surgical treatment regardless of other malignancy risk factors (≥10 mm or ≥15 mm); the definition of significant growth (≥2-4 mm or unequivocal size increase upon visual assessment since the last follow-up); and the use of abdominal Doppler ultrasonography for risk stratification.

Guidelines governing the management of gallbladder polyps vary. The best recommendation is to select the most appropriate guideline based on the behavior of this condition as observed in studies of the specific population receiving medical care.