Gallstones - Treatments

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How are gallstones treated?

Observation

Most gallstones are silent.

  • If silent gallstones are discovered in an individual at age 65 (or older), the chance of developing symptoms from the gallstones is only 20% (or less) assuming a life span of 75 years. In this instance, it is reasonable not to treat the individual.
  • In younger individuals, no treatment also may be appropriate if the individuals have serious, life-threatening diseases, for example, seriousheart disease, that are likely to shorten their life span.
  • On the other hand, in healthy young individuals, treatment should be considered even for silent gallstones because the individuals' chances of developing symptoms from the gallstones over a lifetime will be higher. Once symptoms begin, treatment should be recommended since further symptoms are likely and more serious complications can be prevented.

Cholecystectomy

Cholecystectomy (removal of the gallbladder surgically) is the standard treatment for gallstones in the gallbladder. Surgery may be done through a large abdominal incision, laparoscopically or robotically through small punctures in the abdominal wall. Laparoscopic surgery results in less pain and a faster recovery. Robot-assisted laparoscopic surgery has 3D visualization. Cholecystectomy has a low rate of complications, but serious complications such as damage to the bile ducts and leakage of bile occasionally occur. There also is risk associated with the general anesthesia that is necessary for either type of surgery. Problems following removal of the gallbladder are few. Digestion of food is not affected, and no change in diet is necessary. Chronicdiarrhea occurs in approximately 10% of patients.

Sphincterotomy and extraction of gallstones

Sometimes a gallstone may be stuck in the hepatic or common bile ducts. In such situations, there usually are gallstones in the gallbladder as well, and cholecystectomy is necessary. It may be possible to remove the gallstone stuck in the duct at the time of surgery, but this may not always be possible. An alternative means for removing gallstones in the duct before or after cholecystectomy is with sphincterotomy followed by extraction of the gallstone.

Sphincterotomy involves cutting the muscle of the common bile duct (sphincter) at the junction of the common bile duct and the duodenum in order to allow easier access to the common bile duct. The cutting is done with an electrosurgical instrument passed through the same type of endoscope that is used for ERCP. After the sphincter is cut, instruments may be passed through the endoscope and into the hepatic and common bile ducts to grab and pull out the gallstone or to crush the gallstone. It also is possible to pass a lithotripsy instrument that uses high frequency sound waves to break up the gallstone. Complications of sphincterotomy and extraction of gallstones include risks associated with general anesthesia, perforation of the bile ducts or duodenum, bleeding, and pancreatitis.

Oral dissolution therapy

It is possible to dissolve some cholesterol gallstones with medication taken orally. The medication is a naturally-occurring bile acid called ursodeoxycholic acid or ursodiol (Actigall, Urso). Bile acids are one of the detergents that the liver secretes into bile to dissolve cholesterol. Although one might expect therapy with ursodiol to work by increasing the amount of bile acids in bile and thereby cause the cholesterol in gallstones to dissolve, the mechanism of ursodiol's action actually is different. Ursodiol reduces the amount of cholesterol secreted in bile. The bile then has less cholesterol and becomes capable of dissolving the cholesterol in the gallstones.

There are important limitations to the use of ursodiol:

  • It is only effective for cholesterol gallstones and not pigment gallstones.
  • It works only for small gallstones, less than 1-1.5 cm in diameter.
  • It takes one to two years for the gallstones to dissolve, and many of the gallstones reform following cessation of treatment.

Due to these limitations, ursodiol generally is used only in individuals with smaller gallstones that are likely to have a very high cholesterol content and who are at high risk for surgery because of ill health. It also is reasonable to use ursodiol in individuals whose gallstones were perhaps formed because of a transient event, for example, rapid loss of weight, since the gallstones would not be expected to recur following successful dissolution.

Extracorporeal shock-wave lithotripsy

Extracorporeal shock-wave lithotripsy (ESWL) is an infrequently used method for treating gallstones, particularly those lodged in bile ducts. ESWL generators produces shock waves outside of the body that are then focused on the gallstone. The shock waves shatter the gallstone, and the resulting pieces of the gallstone either drain into the intestine on their own or are extracted endoscopically. Shock waves also can be used to break up gallstones via special catheters passed through an endoscope at the time of ERCP.

Return to Gallstones

See what others are saying

Comment from: 2darls, 35-44 Female (Patient) Published: September 27

My first episode started on December '10, it was after eating dinner during a bday party. I tried to vomit and do bowel movement thinking it will ease up the pain, but it did not. This went on for 5-10 minutes, then I took 2 TUMs which after 15 minutes I was relieved. I said to myself, oh. My first heartburn. Then the second attack came on February'11, I was at work and my co-workers had to lay me down to the floor because they could not even get me up to walk to the bed, they gave me Pepto-Bismol and Nexium at the same time, took 20-30 minutes for my symptom to be relieved. This time I went to the doctor and he then prescribe me to take Prilosec for a month. I did not heed to his advice and thinking losing weight and changing my diet will help with the heartburn instead of taking the medication. I learned too the coffee, then eating with chocolate triggers this episode. I lost weight, modified my diet. However after a day of skipping lunch, followed with a heavy dinner, September 2011, a different kind of pain hit me at 3am. Took tums and thought it will go away after 15 minutes, but did not. Pain went on for another 2-3 hours. Went to the doctor right away and he ordered to have an ultrasound done. Got the ultrasound done after a week, then while shopping for food, intense pain started in the middle of the abdomen, I was having cold sweats, I did a bowel movement thinking it's going to relieve me, but the pain still continues and increased, then more on the right side under my breast.

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Comment from: 55-64 Male (Patient) Published: August 17

I had a large, very fatty dinner and then went to a late movie. I started feeling pain and nausea and thought I'd overeaten. The pain kept getting worse so I left the movie and went home. I had bad chest pains and severe nausea and finally drove myself to the ER thinking that I was having a heart attack. The pain was severe enough that the first shot of morphine didn't touch it. A second shot alleviated the pain and anti-nausea helped. They EKG'd and then x-rayed me and determined that I had gallstones. The doctor told me that I didn't need emergency surgery and that I'd be okay as long as I kept to a very low to no fat diet. That's what I've done and now almost 2 months later I haven't had any more episodes. In fact, watching my diet and exercising I've lost 23 pounds, so oddly it's been a good thing for me. I haven't determined yet whether I'll have the surgery (I miss my desserts...), but for now feel like I'm on the right track health-wise. This is a guess, but I started cholesterol pills last year. I wonder if that contributed. The rapid weight loss, which this article said could contribute, came after the attack. I'm not aware of any history in my family, though that doesn't mean it hasn't been there.

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