Current management of gallstone disease

Kim, Tae Hyeon

Abstract

In asymptomatic gallstone patients, the risk of developing symptoms or complications requiring surgery is small in the range of 1~4% per year. Thus a recommendation for cholecystectomy in a patient with gallstones should probably be based on assessment of three factors: (1) the symptoms that are frequent enough or severe enough to interfere with the patient's general routine; (2) the presence of a prior complication of gallstone disease or (3) the presence of an underlying condition predisposing the patient to increased risk of gallstone complications (e.g., calcified or porcelain gallbladder and/or a previous attack of acute cholecystitis). Laparoscopic cholecystectomy is the procedure of choice for most patients with gallbladder stones. Its advantages include a markedly shortened hospital stay, minimal disability, as well as decreased cost. In carefully selected patients with a functioning gallbladder and with radiolucent stones <5 mm in diameter, complete dissolution can be achieved in ~50% of patients with ursodeoxycholic acid (UDCA). Early cholecystectomy is considered the treatment of choice of acute cholecystitis. In the small minority of patients with severe acute cholecystitis or who are poor candidates for surgery, initial conservative management with antibiotics is recommended with percutanous cholecystostomy.