What does the MRI demonstrate? What is the next appropriate step in the management?
There are multiple polypoid lesions of the GB. No extramural invasion to indicate malignancy. The risk of malignancy is higher in gallbladder polyps greater than 10mm and therefore this patient should be referred to a surgeon for consideration of cholecystectomy.
What does the MRCP demonstrate? Would this change your suggestion for further follow-up/management?
The MRCP demonstrates multiple intrahepatic and extrahepatic biliary strictures consistent with multifocal cholangiopathy. In a patient with UC, this would be in keeping with primary sclerosing cholangitis (PSC). Patients with PSC are at increased risk of GB carcinoma and therefore all patients with GB polyps should be referred for consideration for cholecystectomy, regardless of polyp size. In this case, the polyp size would already be an indication for referral. Depending on local expertise, it may be appropriate to refer to a specialist HPB surgeon for cholecystectomy.
There are multiple polypoid lesions of the GB. No extramural invasion to indicate malignancy.