Gallbladder polyps: ultrasound diagnosis, updated guidelines, and clinical management

Abstract

Ultrasound is a relevant tool in the diagnosis and characterization of gallbladder polyps. B-mode imaging can be used for the identification of echogenic formations attached to the gallbladder wall, while advanced techniques such as color Doppler, power Doppler, and micro-flow allow a thorough assessment of polyp vascularization. The integration of CEUS further improves diagnostic accuracy by confirming the integrity of the wall and the absence of pathological washout, which is characteristic of malignant lesions. In recent years, several guidelines have been published on the integrated clinical and ultrasound management of polypoid formations of the gallbladder. This review aims to summarize the main evidence regarding the ultrasound study of gallbladder polyps and to provide the sonographer with a clear and practical approach to the clinical management and follow-up of these patients.

Zusammenfassung

Ultraschall ist ein wichtiges Instrument zur Diagnose und Charakterisierung von Gallenblasen-Polypen. Die B-Bildgebung kann zur Identifizierung echogener Strukturen an der Gallenblasenwand eingesetzt werden, während modernere Techniken wie Farbdoppler, Power-Doppler und Microflow eine eingehende Beurteilung der Vaskularisation der Polypen ermöglichen. Die Kombination mit dem CEUS (kontrastmittelverstärkter Ultraschall) verbessert die diagnostische Genauigkeit zusätzlich, indem sie die Integrität der Wand und das Fehlen eines pathologischen Wash-outs bestätigt, der für maligne Läsionen charakteristisch ist. In den letzten Jahren wurden mehrere Leitlinien zur integrierten klinischen und ultraschallgestützten Behandlung polypoider Formationen der Gallenblase veröffentlicht. Diese Übersichtsarbeit fasst die wichtigsten evidenzbasierten Erkenntnisse zur Ultraschall-Untersuchung von Gallenblasen-Polypen zusammen und bietet dem Ultraschall-Diagnostiker einen klaren und praxisorientierten Ansatz für die klinische Behandlung und Nachsorge dieser Patienten.

Keywords

gallbladder - polyp - ultrasound - CEUS - neoplasm

Publication History

Received: 26 October 2024

Accepted after revision: 14 July 2025

Article published online:
17 September 2025

• References

• 1 Cocco G, Basilico R, Delli Pizzi A. et al. Gallbladder polyps ultrasound: what the sonographer needs to know. J Ultrasound 2021; 24: 131-142
• 2 Fujimoto T, Kato Y. Gallbladder Cholesterol Polyp Covered by Viscous Biliary Sludge, Mimicking T1a Carcinoma. J Clin Ultrasound 2025;
• 3 Tazeoglu D, Esmer AC. Differentiation of “Polyp” and “Pseudo Polyp” in Gallbladder Polyps, Single-center Experience. Surg Laparosc Endosc Percutan Tech 2025;
• 4 Zhang Y, Hao J, Wang P. et al. Development and Validation of a Preoperative Prediction Model for Neoplastic Gallbladder Polyps. Br J Hosp Med (Lond) 2025; 86: 1-15
• 5 Jo IH, Paik CN, Ahn HG. et al. Predicting Neoplastic Gallbladder Polyps: The Role of Current Surgical Indications and Preoperative Images. Korean J Gastroenterol 2025; 85: 52-63
• 6 Chidambaram R, Wijesuriya R, Pradhan S. An approach to managing gallbladder polyps for the general practitioner. Aust J Gen Pract 2024; 53: 480-484
• 7 Li Q, Dou M, Liu H. et al. Prediction of neoplastic gallbladder polyps in patients with different age level based on preoperative ultrasound: a multi-center retrospective real-world study. BMC Gastroenterol 2024; 24: 146
• 8 Kwon OS, Kim YK, Kim HJ. Retrospective Study of the Prevalence and Associated Factors of Gallbladder Polyps among Residents of Two Korean Cities. J Clin Med 2024; 13
• 9 Boccatonda A, Del Cane L, Marola L. et al. Platelet, Antiplatelet Therapy and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review. Life (Basel) 2024; 14
• 10 Sogabe M, Okahisa T, Kagawa M. et al. Metabolic dysfunction-associated steatotic liver disease and gallbladder polyp development: an observational study. Sci Rep 2024; 14: 22446
• 11 van Erp LW, Cunningham M, Narasimman M. et al. Risk of gallbladder cancer in patients with primary sclerosing cholangitis and radiographically detected gallbladder polyps. Liver Int 2020; 40: 382-392
• 12 Dou M, Liu H, Tang Z. et al. Non-invasive classification of non-neoplastic and neoplastic gallbladder polyps based on clinical imaging and ultrasound radiomics features: An interpretable machine learning model. Eur J Surg Oncol 2025; 51: 109709
• 13 Wang X, Zhang H, Bai Z. et al. Current status of artificial intelligence analysis for the diagnosis of gallbladder diseases using ultrasonography: a scoping review. Transl Gastroenterol Hepatol 2025; 10: 12
• 14 Boccatonda A, D'Ardes D, Tallarico V. et al. Gastrointestinal Ultrasound in Emergency Setting. J Clin Med 2023; 12
• 15 Strnad BS, Konstantinoff KS, Ludwig DR. Challenges in Ultrasound of the Gallbladder and Bile Ducts: A Focused Review and Update. Radiol Clin North Am 2025; 63: 45-55
• 16 Elias ZF, Lee SY. Contrast-enhanced ultrasound for differentiation of gallbladder sludge from polyp: A case report demonstrating clinical utility. Radiol Case Rep 2025; 20: 2980-2983
• 17 He Z, Yang S, Cao J. et al. Predicting Neoplastic Polyp in Patients With Gallbladder Polyps Using Interpretable Machine Learning Models: Retrospective Cohort Study. Cancer Med 2025; 14: e70739
• 18 Fei X, Cheng Z, Zhu L. et al. A practical contrast-enhanced ultrasound risk prediction of gallbladder polyp: differentiation of adenoma from cholesterol polyp lesion. Abdom Radiol (NY) 2025; 50: 747-756
• 19 Lowin J, Sewell B, Prettyjohns M. et al. Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom. Br J Radiol 2025; 98: 693-700
• 20 Elmasry M, Lindop D, Dunne DF. et al. The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review. Int J Surg 2016; 33 Pt A: 28-35
• 21 Chai JL, Baranov E, Licaros AR. et al. Sonographic Characteristics of ≥7 mm Gallbladder Polyps: A Retrospective Analysis. J Ultrasound Med 2025; 44: 57-66
• 22 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Short Version). Ultraschall in Med 2018; 39: 154-180
• 23 Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg 2018; 61: 200-207
• 24 Kamaya A, Fung C, Szpakowski JL. et al. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305: 277-289
• 25 Anderson MA, Mercaldo S, Cao J. et al. Society of Radiologists in Ultrasound Consensus Conference Recommendations for Incidental Gallbladder Polyp Management: Interreader Agreement Among Ten Radiologists. AJR Am J Roentgenol 2024;
• 26 Mugu VK, Carr BM, Olson MC. et al. Increasing Adherence to Societal Recommendations in Radiology Reporting: A Feasibility Study Using Society of Radiologists in Ultrasound Guidelines for Incidentally Detected Gallbladder Polyps. Ultrasound Q 2025; 41
• 27 Garcia L, Dygean F, Bortree E. et al. A comparison of society guidelines in the management of gallbladder polyps. Am J Surg 2025; 240: 116099
• 28 Jeans M, Dragh M, Necas M. et al. Size and Morphology of Ultrasound Detected Gallbladder Polyps and the Surveillance Implications of Adopting the Society of Radiologists in Ultrasound Consensus Conference Recommendations: A Waikato Experience. J Med Imaging Radiat Oncol 2025;
• 29 Foley KG, Lahaye MJ, Thoeni RF. 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
• 30 Jenssen C, Lorentzen T, Dietrich CF. et al. Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper. Ultrasound Med Biol 2022; 48: 2355-2378
• 31 de Sio I, D’Onofrio M, Mirk P. et al. SIUMB recommendations on the use of ultrasound in neoplastic lesions of the gallbladder and extrahepatic biliary tract. J Ultrasound 2023; 26: 725-731
• 32 Chang W, Lee S, Kim YY. et al. Interpretation, Reporting, Imaging-Based Workups, and Surveillance of Incidentally Detected Gallbladder Polyps and Gallbladder Wall Thickening: 2025 Recommendations From the Korean Society of Abdominal Radiology. Korean J Radiol 2025; 26: 102-134
• 33 Andrén-Sandberg A. Diagnosis and management of gallbladder polyps. N Am J Med Sci 2012; 4: 203-211
• 34 Gupta P, Dutta U, Rana P. et al. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdom Radiol (NY) 2022; 47: 554-565
• 35 Joo I, Lee JY, Kim JH. et al. Differentiation of adenomyomatosis of the gallbladder from early-stage, wall-thickening-type gallbladder cancer using high-resolution ultrasound. Eur Radiol 2013; 23: 730-738
• 36 Oh SH, Han HY, Kim HJ. Comet tail artifact on ultrasonography: is it a reliable finding of benign gallbladder diseases?. Ultrasonography 2019; 38: 221-230
• 37 Soundararajan R, Subramanian P, Gupta P. et al. Agreement of Gallbladder Reporting and Data System for Gallbladder Wall Thickening at Ultrasonography: A Multireader Validation Study. J Clin Exp Hepatol 2024; 14: 101393
• 38 Wang R, Lv L, Li L. Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population. Front Oncol 2024; 14: 1367351
• 39 Zheng SG, Xu HX, Liu LN. et al. Contrast-enhanced ultrasound versus conventional ultrasound in the diagnosis of polypoid lesion of gallbladder: a multi-center study of dynamic microvascularization. Clin Hemorheol Microcirc 2013; 55: 359-374
• 40 Boccatonda A, Cocco G, D’Ardes D. et al. GB-RADS score, a possible role for CEUS?. Abdom Radiol (NY) 2023; 48: 1199-1201
• 41 Corwin MT, Siewert B, Sheiman RG. et al. Incidentally detected gallbladder polyps: is follow-up necessary? – Long-term clinical and US analysis of 346 patients. Radiology 2011; 258: 277-282
• 42 Cocco G, Delli Pizzi A, Basilico R. et al. Imaging of gallbladder metastasis. Insights Imaging 2021; 12: 100