Saif Ullah1, Dan Liu1, Si-Ran Zhou1, Bing-Rong Liu1

1The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Background/Aims: Gallbladder polyps are one of the most common digestive health problems with a worldwide prevalence of 5-7%. Cholecystectomy remains the first-line treatment for gallbladder polyps larger than 10 mm to reduce the risk of malignant transformation. However, it is reported that Cholecystectomy itself is associated with post-cholecystectomy syndromes, bile duct injury, and colon cancer. These concerns have been listed among the reasons for gallbladder preservation. This study’s goals were to evaluate the feasibility, safety, and efficacy of pure NOTES trans-rectal gallbladder preserving cholecystopolypectomy. 

Methods: This is a retrospective study of consecutive patients who underwent pure NOTES cholecystopolypectomy at the First Affiliated Hospital of Zhengzhou University between June 2015 and July 2020. Patient's demographics, imaging data, procedural parameters (Success rate, reoccurrence, complications) and final histopathology were manually reviewed.

Results: A total of 36 patients (mean age, 44.4±12.9 years; 58.3% men) with 128 lesions underwent NOTES gallbladder preserving cholecystopolypectomy (Figure 1). The procedure technical success rate was 100%. Single lesion was resected in 13 patients (36.1%) and multiple lesions (range, 2-20) were removed in 23 (63.9%) patients. The mean size of total polyps was 6.1 mm. Post-operatively, in 3 patients (8.3%) abdominal pain was observed, and all of them were managed conservatively. No reoccurrences observed during a mean follow up of 16 months. Histopathology showed pre-malignant lesion (adenoma) in 2 cases (5.6%), non-neoplastic lesion in 34 cases (including hyperplasic in 18 cases, cholesterol in 14 cases, and inflammation in 2 patients).

Conclusion: Pure NOTES cholecystopolypectomy appears to be feasible, safe, and effective in treating gallbladder polyps. This technique not only removes the neoplastic or non-neoplastic lesions, which eliminate the risk of malignant transformation, but also preserve the biological function of gallbladder. However, this was a single-center study with unavoidable bias. Multicenter randomized controlled clinical trial should be done before final recommendations are made.

Keywords: Gallbladder polyps, Cholecystopolypectomy, Gallbladder preservation, NOTES, Organ retention