Most small gallbladder polyps are benign and do not change significantly over time. They are usually incidental findings on ultrasound. Therefore, these polyps should be checked periodically with routine percutaneous ultrasonography. In the asymptomatic patient, gallbladder polyps that are greater than 1 cm in diameter should be treated with cholecystectomy. The size of the polyp and the patient greater than 50 years are important risk factors for malignant potential. Patients who have biliary pain and small gallbladder polyps without gallstones present a difficult management decision for the clinician. If the physician is confident that the polyps are the source of the pain, patients should be referred for cholecystectomy. Endoscopic ultrasound and positron emission tomography may prove to be useful in assessing the malignant potential of large gallbladder polyps. Laparoscopic cholecystectomy is the treatment of choice for most gallbladder polyps. If a malignant polyp is suspected, patients should undergo an open cholecystectomy.