SRU Gallbladder Polyp Follow-up (2022 Consensus)

The 2022 SRU consensus (Kamaya et al., Radiology 2022) stratifies gallbladder polyps by ultrasound morphology rather than patient risk factors. Pedunculated polyps with a "ball-on-the-wall" configuration or a thin stalk are extremely low risk; sessile polyps and pedunculated polyps with a thick or wide stalk are low risk; and any polyp with adjacent focal gallbladder wall thickening of 4 mm or more is indeterminate risk. Extremely-low-risk polyps need no follow-up up to 9 mm, ultrasound at 6/12/24 months at 10–14 mm, and surgical consultation at 15 mm or more. Low-risk polyps need no follow-up up to 6 mm, a 12-month ultrasound at 7–9 mm, ultrasound at 6/12/24/36 months or surgical consultation at 10–14 mm, and surgical consultation at 15 mm or more. Indeterminate-risk polyps of 6 mm or less get ultrasound at 6/12/24/36 months or surgical consultation, and those 7 mm or more go to surgical consultation. During follow-up, growth of 4 mm or more within 12 months — or reaching the category size threshold — triggers surgical consultation, while a decrease of 4 mm or more ends surveillance. Size is rounded to the nearest millimetre and recommendations target the largest polyp; polyp number and vascularity do not alter stratification, and when the category is uncertain the low-risk pathway should be used. Polyps in patients with primary sclerosing cholangitis are excluded and managed under specialty (ACG) guidance, and the consensus optionally allows extremely-low-risk polyps in patients of North Indian or Indigenous North/South American heritage to be managed as low risk.