Gallstones and Gallbladder Disease - Treatment

Treatment

Acute pain from gallstones and gallbladder disease is usually treated in the hospital, where diagnostic procedures are performed to rule out other conditions and complications. There are three approaches to gallstone treatment:

• Expectant management ("wait and see")
• Nonsurgical removal of the stones
• Surgical removal of the gallbladder

Expectant Management of Asymptomatic Gallstones

Guidelines from the American College of Physicians state that when a person has no symptoms, the risks of both surgical and nonsurgical treatments for gallstones outweigh the benefits. Experts suggest a wait-and-see approach, which they have termed expectant management, for these patients. Exceptions to this policy are people who cholangiography shows are at risk for complications from gallstones, including the following:

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• Those at risk for gallbladder cancer
• Pima Native Americans
• Patients with stones larger than 3 cm

Very small gallstones (smaller than 5 mm) may increase the risk for acute pancreatitis, a serious condition.

There are some minor risks with expectant management for people who do not have symptoms or who are at low risk. Gallstones almost never spontaneously disappear, except sometimes when they are formed under special circumstances, such as pregnancy or sudden weight loss. At some point, the stones may cause pain, complications, or both, and require treatment. Some studies suggest the patient's age at diagnosis may be a factor in the possibility of future surgery. The probabilities are as follows:

• 15% likelihood of future surgery at age 70
• 20% likelihood of future surgery at age 50
• 30% likelihood of future surgery at age 30

The slight risk of developing gallbladder cancer might encourage young adults who do not have symptoms to have their gallbladder removed.

Symptomatic patients

Gallstones are the most common cause for emergency room and hospital admissions of patients with severe abdominal pain. Many other patients experience milder symptoms. Results of diagnostic tests and the exam will guide the treatment, as follows:

Normal Test Results and No Severe Pain or Complications. Patients with no fever or serious medical problems who show no signs of severe pain or complications and have normal laboratory tests may be discharged from the hospital with oral antibiotics and pain relievers.