Association between cholecystectomy/gallbladder pathology and colorectal polyps: a systematic review and meta-analysis

Shirui Li¹Yunfan Deng¹Sheng Dai²Qi Fan³Dehai Xiong^3*Xiuyang Li^1*

• ¹Department of Big Data in Health Sciences, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
• ²Zhejiang University School of Medicine Sir Run Run Shaw Hospital Department of General Surgery, Hangzhou, China
• ³People's Hospital Affiliated to Chongqing Three Gorges Medical College, Chongqing, China

Background: Gallbladder-related pathologies may influence colorectal carcinogenesis, yet systematic evaluation of their associations with precursor lesions remains limited. This study addresses critical knowledge gaps by investigating the dual-axis relationship between cholecystectomy/gallbladder pathologies and colorectal polyp risk while elucidating geographical and biological effect modifiers. Methods: In accordance with the MOOSE/Cochrane guidelines, 27 observational studies were analysed through PROSPERO (CRD420251012876). Comprehensive meta-analysis was performed to assess the effects of cholecystectomy across polyp subtypes and gallbladder pathology (stones/polyps) associations. Heterogeneity was quantified via I² statistics, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via the DerSimonian‒Laird random effects model to account for between-study variance. Subgroup analysis stratified by geography, pathology type, and adjustment model was performed with χ² tests for subgroup differences. Sensitivity analysis and publication bias were assessed through leave-one-out methods, funnel plots and Egger's test. Results: Cholecystectomy was associated with a 39% increased risk (OR=1.39, 95% CI: 1.21–1.59), with East Asian populations exhibiting a nearly doubled risk compared with North American populations (OR=1.95 vs. 1.16; P=0.002). Compared with unclassified polyps, adenomas were more strongly associated (OR=1.37, 95% CI: 1.16–1.62). Medium-sized studies (OR=1.69, 95% CI: 1.36–2.11) and those adjusted for health factors (OR = 1.34, 95% CI: 1.12–1.61) yielded higher estimates, whereas dietary adjustment nullified significance. Gallbladder pathology (stones/polyps) conferred a 27% higher risk overall, with gallbladder polyps showing greater risk (OR=1.30, 95% CI: 1.17--1.38) than stones (OR=1.20, 95% CI: 1.08--1.32). Older populations (≥50 years) had stronger associations (OR=1.41 vs. 1.20 in younger groups). Adjustment for smoking, alcohol, and BMI strengthened the estimates (OR=1.43, 95% CI: 1.22--1.68). Sensitivity analysis supported the robustness of the primary findings, particularly for cholecystectomy. Conclusions: This comprehensive analysis establishes gallbladder status as an independent risk modulator for early colorectal lesions, with cholecystectomy demonstrating the highest risk magnitude. These findings advocate personalized