Incidental gallbladder (GB) polyps are common, seen in 3-6% of the general population, often benign cholesterol polyps. Few GB polyps (6%) are neoplastic (intracholecystic papillary neoplasm, ICPN). While ICPNs have malignant potential, malignant transformation is believed rare. GB cancers also typically arise from flat dysplastic epithelium, not polyps. Yet the concern a small polyp may harbor a future or early neoplasm has led past guidelines to suggest relatively aggressive management; recent studies show significant overtreatment of predominantly benign GB lesions.In 2021 the Society of Radiologists in Ultrasound (SRU) convened a multidisciplinary committee to review current literature and construct updated guidelines for the management of incidentally detected GB polyps. The SRU Guidelines, to be published in 2022 (Radiology), stratify risk into three categories: Extremely Low, Low, and Indeterminate Risk. Clinical examples and common questions will be addressed.

1. Background and review of prior guidelines a. Overview of gallbladder polyps and underlying pathology b. Discussion of current literature and recommendations2. 2021 SRU Gallbladder Polyp Consensus Recommendations a. Applicable and excluded patient populationsb. Risk Categories: Extremely Low Risk, Low Risk, Indeterminate Risk3. Common and uncommon clinical scenarios a. Polyp measurement b. Sessile versus pedunculated c. Determination of growth d. Doppler assessment e. Multiple versus single gallbladder polyps f. The role of alternative modalities such as contrast-enhanced ultrasound and MRI g. Other risk factors: primary sclerosing cholangitis, age, ethnicity, geographic location