How Should Asymptomatic Gallstones Be Managed?

Question

How should silent or asymptomatic gallstones be managed? Which patients require cholecystectomy?

Response from John Baillie, MB ChB, FRCP Professor of Medicine; Director, Hepatobiliary and Pancreatic Disorders Service, Wake Forest University Baptist Medical Center and Health Sciences, Winston-Salem, North Carolina

Asymptomatic gallstones are very common.

The consensus is that with a few exceptions, as identified below, asymptomatic gallstones should be left alone. Most patients with asymptomatic gallstones will never develop symptoms.

However, once gallstones become symptomatic, causing biliary colic, acute pancreatitis, acute cholangitis, jaundice, and other symptoms, the gallbladder should be removed because the symptoms tend to recur, and the associated clinical syndromes have the potential to be severe (eg, necrotizing pancreatitis).

Who Needs Cholecystectomy for Asymptomatic Gallstones?

Patients with diabetes mellitus are advised to have cholecystectomy for asymptomatic stones because these patients tend to have more complications related to acute surgery than patients without diabetes.

Patients who are found to have a solitary large gallstone occupying the entire lumen of the gallbladder are at an increased risk for gallbladder cancer; therefore, they are advised to have prophylactic cholecystectomy.

Finally, patients with no other risk factors but who are going to be living or traveling for a long period of time in a location that is far from basic medical care (eg, launched into space, wintering at a scientific base in Antarctica) are advised to have cholecystectomy prophylactically, because they may not have ready access to a surgeon or therapeutic endoscopist when their gallstones begin to "act up."

Medscape Gastroenterology © 2010  WebMD, LLC

Cite this: John Baillie. How Should Asymptomatic Gallstones Be Managed? - Medscape - Nov 16, 2010.