Natural orifice transluminal endoscopic gallbladder-preserving polypectomy: the real-world largest cohort study (with video)

BACKGROUND Although most gallbladder polyps (GPs) are benign pseudopolyps without malignant potential, the histopathological diagnosis can be obtained by cholecystectomy. Polypectomy via trans-rectal/gastric natural orifice transluminal endoscopic surgery (NOTES-GPP) offers an effective method for gallbladder polyps treatment with gallbladder-preserving fashion. Currently, NOTES-GPP is not widely used worldwide. In this study, we present a cohort analysis with an extended follow-up period to clarify the safety and reliability of NOTES-GPP. METHODS All patients who underwent NOTES-GPP at the first affiliated hospital of Zhengzhou University from January 2015 and May 2023 were enrolled in this study. Technical feasibility and clinical outcome including recurrence on long-term follow-up were explored. RESULTS Seventy-four patients who underwent NOTES-GPP were collected with median follow-up of 25 months. Technical success was achieved in all patients, and there were only mild and moderate adverse events that occurred. During follow-up, 2 patients underwent additional cholecystectomy due to cholecystitis at postoperative 9- and 12-month, respectively. Gallbladder polyp recurrence was observed in 8 (11.0%) patients at a median postoperative follow-up of 20.50 months, with pathological results following NOTES-GPP identified as cholesterol polyp. CONCLUSIONS NOTES-GPP for gallbladder polyp is a feasible and safe method, which allows for gallbladder preservation and acceptable recurrence rate. Yet, this approach to gallbladder polyp removal does require that patients undergo close follow-up.