Objective: To investigate the natural evolution process of polypoid lesion of the gallbladder, so as to provide a reference for determination of its indications for surgery. Methods: Two-hundred patients with polypoid lesions of the gallbladder who had consecutive ultrasonographic data within 3 years were collected. The ultrasonic characteristics of the changes in size and number of their lesions were analyzed. Results: Among the 200 patients with polypoid lesion, 79 cases (39.5%) had single lesion, and 121 cases (60.5%) multiple lesions. The diameter of lesion in 113 cases (56.5%, that included 45 cases with single lesion) was ≥5 mm, in 87 cases (43.5%) was <5 mm, and in none of them was >1 cm. During 3 years of follow-up, the lesions were found to be reduced in size in 8 cases, disappeared in 10 cases and unchanged in 161 cases, which accounted for 89.5% (179/200) of the whole group. The lesions were found to be enlarged in only 21 cases (10.5%), but no lesion was greater than 1 cm. Conclusion: The majority of polypoid lesions of the gallbladder grow very slowly and are benign lesions, and can be managed by regular follow-up with no need of surgical treatment.