SERVICE EVALUATION OF GALLBLADDER POLYP ULTRASOUND SURVEILLANCE Dr

SERVICE EVALUATION OF GALLBLADDER POLYP ULTRASOUND SURVEILLANCE Dr Marvin Daglish Radiology Registrar, University Hospital Southampton Dr Jamie Franklin Consultant Radiologist, Royal Bournemouth & Christchurch Hospitals

BACKGROUND Gallbladder polyps (GBPs) commonly detected on abdominal US Majority are non-neoplastic (inflammatory, cholesterol) A small number become malignant

BACKGROUND Gallbladder polyps (GBPs) commonly detected on abdominal US Majority are non-neoplastic (inflammatory, cholesterol) A small number become malignant GB cancer is uncommon Prognosis poor when advanced High treatment costs (£ 60 k pa) 20 min US (£ 40) + cholecystectomy (£ 2 -3000)

BACKGROUND (2) European guidelines (ESGAR) 2017: GBP management and follow-up Local GBP US surveillance guidelines since 2011 Aim: evaluation of local surveillance to inform an update

METHODOLOGY Retrospective analysis: newly detected GBPs on US throughout 2012 via RIS search. Recorded: GBP baseline size & changes, US recommendations, actual follow-up, cholecystectomy results. Electronic records & results reviewed 2012 - February 2019.

LOCAL GBP GUIDELINES (largest diameter) <3 mm: no surveillance. 3 -5 mm: 12 month US 5 -9 mm: 6 and 18 month US (from detection) Stable -> discharge. Increased at any time or ≥ 10 mm: refer - cholecystectomy.

QUESTIONS/INDICATORS (target) GBPs requiring surveillance (3 -9 mm): 1. Reports recommending follow-up as per guidelines (95%) 2. Patients completing follow-up as per guidelines (80%) GBPs ≥ 10 mm or increasing in size: 3. Reports recommending referral (95%).

RESULTS 123 GBPs in 2012

RESULTS 31 GBPs < 3 mm (25. 2%) 6 GBPs ≥ 10 mm (4. 9%) 123 GBPs in 2012

RESULTS 31 GBPs < 3 mm (25. 2%) 6 GBPs ≥ 10 mm (4. 9%) 123 GBPs in 2012 86 requiring surveillance (3 -9 mm) (69. 9%)

RESULTS 31 GBPs < 3 mm (25. 2%) 6 GBPs ≥ 10 mm (4. 9%) 123 GBPs in 2012 86 requiring surveillance (3 -9 mm) (69. 9%) 1. 55 reports (64%) recommended follow-up (target 95%) 2. 31 completed follow-up (36%) (target 80%)

RESULTS (2) Of the 123 GBPs: 12 required referral: 6 GBPs ≥ 10 mm + 6 GBPs grew 3. 5 reports (42. 7%) recommended referral (target 95%)

RESULTS (2) Of the 123 GBPs: 12 required referral: 6 GBPs ≥ 10 mm + 6 GBPs grew 3. 5 reports (42. 7%) recommended referral (target 95%) Total of 11 referred for cholecystectomy: 1 incidental focus of LG dysplasia Other GBPs benign. No known cases of GB cancer

DISCUSSION Poor compliance with surveillance (36%) But similar to other UK centres (Addenbrookes, HPB 2018)

EUROPEAN GUIDELINES 2017

DISCUSSION (2) European guidelines would increase demand on US and Surgical services Vs. improved GB cancer outcomes and treatment cost Improved compliance with surveillance: raising awareness with dept/clinicians standardised reporting automatic generation of follow-up appointments auditing

REFERENCES 1. Wiles R, et al, Management and follow-up of gallbladder polyps, Eur Radiol (2017) 27: 3856– 3866. 2. Patel K, et al. , Five year experience of gallbladder polyp surveillance and cost effective analysis against new European consensus guidelines, HPB (2018).