Gallstones - Treatment in Adults
Gallstones - Treatment in Adults
Gallstones - Treatment in Adults
This guideline provides recommendations for the management of asymptomatic and uncomplicated
symptomatic gallstones in adults.
Surgical consultation and surgery are not recommended for adults who have asymptomatic gallstones,
found incidentally by diagnostic imaging or abdominal surgery.
a) Surgical intervention
b) Non-surgical management
(i) Oral bile acids are rarely indicated for dissolution therapy in patients who are unsuitable for, or who
decline, surgery.
(ii) Lithotripsy is not indicated for the primary treatment of simple gallstone disease.
Rationale
Gallstones are common in western society. The prevalence is higher in women and increases with
age.2,3
Note: Diabetes mellitus and oral contraceptives are strongly associated with, but are not conclusively
proven to cause, gallstones 3
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Most gallstones are asymptomatic and remain so for the life of the patient.2,4-6 Complications or
symptoms will develop in one to two per cent of patients per year. It also appears that the longer the
stones remain quiescent, the less likely complications appear.
Surgery is not indicated in asymptomatic patients.5-7 Some exceptions include patients with sickle
cell disease and gallstones, and patients with calcified (“porcelain”) gallbladders where the risk of
gallbladder cancer is high.5,6,8 Prophylactic cholecystectomy has previously been recommended in
diabetic patients in order to avoid the high morbidity and mortality rates associated with emergency
operations. However, the increased risks are due to cardiovascular disease and other comorbid
conditions which are present whether the surgery is elective or emergency. Therefore, asymptomatic
patients with diabetes should not have prophylactic surgery.5
There is sometimes confusion about which symptoms are caused by gallstones. Symptoms such
as “indigestion” and “abdominal discomfort” have equal incidence in patients with and without
gallstones.4,6 Biliary pain typically presents as discrete episodes of right upper-quadrant pain and
may last for hours. Only symptoms directly attributable to gallstones will resolve with surgery.6,9
The presence of mild or occasional symptoms does not connote significantly increased risk for
complications compared to asymptomatic patients. Therapeutic decisions should be based on
symptoms, and not on the number or size of gallstones.
References
Sponsors
This guideline was developed by the Guidelines and Protocols Advisory Committee, and supercedes
the guideline Treatment of Gallstones in Adults (September 2001). This guideline has been approved
by the British Columbia Medical Association and adopted by the Medical Services Commission.
Gallstones – Treatment
in Adults
This guideline is based on scientific evidence current as of the Effective Date.
Associated Document
If you have mild infrequent symptoms from your gallstones, you may safely wait to see if your
symptoms worsen. With more frequent or severe symptoms, you may wish to consider surgical
removal of the gallbladder. Simply removing the stones without removing the gallbladder is not an
adequate long-term treatment because of recurrence.
In rare cases when an individual cannot safely have surgery, non-surgical methods may be considered.
However, gallstones commonly recur after non-surgical treatment.
As with all treatments, there are both benefits and risks. You should discuss your options with
your doctor.
Resources
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