Nonsurgical Treatment Options for Gallstones

The treatment of gallstones usually involves surgical removal of the gallbladder
The treatment of gallstones usually involves surgical removal of the gallbladder

If people are unable to go through surgery, there are different treatment options. Here are several alternatives to surgery:

  • Medication: In early cases of gallstones, medications such as ursodiol or chenodiol can dissolve some gallstones. They are available as oral bile acid pills. These medications cause thinning of the bile, helping gallstones dissolve. Medication to reduce cholesterol levels in the bile may help dissolve certain types of gallstones, but they are not very effective. These medications usually take years to work and do not prevent a recurrence.
  • Extracorporeal shock-wave lithotripsy (ECSWL): ECSWL is a non-surgical treatment that uses shock waves to break down/fragment the gallstones if they are less than 2 cm in diameter. The shock waves are sent through the soft tissue of the body. This is also used to treat kidney stones
  • Methyl tertiary-butyl ether (MTBE) Injection: This nonsurgical treatment involves injecting a solvent called MTBE into the gallbladder to dissolve the gallstones. Its side effect could be severe burning pain.
  • Endoscopic drainage: This treatment involves passing an endoscope (a thin tube attached to a camera and light) through the mouth, down the throat, and into the gallbladder. A wire is passed through the duct and into the gallbladder. This treatment allows the gallbladder to resume normal bile drainage.
  • Percutaneous cholecystostomy (PC): This is a nonsurgical treatment option, but it’s most effective when followed by gallbladder removal. PC is ideal for seriously ill patients who are not fit for surgery immediately. The procedure involves using a needle to withdraw fluid from the gallbladder followed by inserting a catheter through the skin to drain the fluid. The catheter is usually left in place for a few weeks, after which the gallbladder removal surgery may be performed to prevent a recurrence.
  • Transmural drainage: It involves creating a new track through the stomach into the gallbladder and a metal stent is placed, allowing the gallbladder to drain into the small intestine. 
  • Acute cholecystostomy, an ultrasound-guided drainage procedure: In patients with acute cholecystitis, cholecystostomy may be performed for those who are unable to undergo surgery. An endoscopic stent is placed between the gallbladder and intestine to drain the infection.

What are gallstones?

The gallbladder is a small pear-shaped organ located below the liver on the right side of the abdomen. The main function of the gallbladder is to store bile, a substance secreted by the liver that is required for digestion. Bile contents in the bile may sometimes crystallize and form gallstones. They may be as small as a grain of salt or as large as a tennis ball, causing serious complications.

The treatment of gallstones usually involves surgical removal of the gallbladder. If gallstones are not very large, the doctor may advise nonsurgical treatment methods to dissolve the gallstones. Nonsurgical treatment is typically done for cholesterol gallstones. The other type of gallstones, called pigment gallstones, usually need surgery.

There may be no symptoms in the initial stages. Some signs and symptoms that may develop later are as follows:

  • Pain in the right upper abdomen, which may be mild or severe 
  • Back pain
  • Digestive discomfort, especially after a heavy meal 
  • Tenderness over the right upper abdomen 
  • Fever with chills, in case of infection 
  • Nausea and vomiting 


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Do gallstones require treatment?

If there are no symptoms, observation and regular follow-up may be done. In the presence of symptoms, treatment for gallstones is necessary to relieve symptoms and to avoid serious complications. Surgery may be required if nonsurgical treatments are not possible and if there is a recurrence, with a high risk of complications.

Complications of gallstones may include:

  • Inflammation of the gallbladder: Gallstones can block the ducts inside the gallbladder or neck of the gallbladder, causing the gallbladder to become inflamed or infected. This is called cholecystitis. Cholecystitis can cause severe pain and fever.
  • Blockage of the common bile duct: A gallstone may pass out of the gallbladder duct and into the main bile duct, leading to bile duct infection that can eventually cause pancreatitis (inflammation of the pancreas). This causes severe pain, jaundice, and infection.
  • Blockage of the pancreatic duct: The pancreatic duct is a tube that connects the pancreas to the common bile duct just before opening into the duodenum. The flow of pancreatic juices, which aid in digestion, gets blocked if the pancreatic duct is blocked by gallstones. This leads to pancreatitis (inflammation of the pancreas). It causes intense, constant abdominal pain and usually requires hospitalization.
  • Gallbladder cancer: Although extremely rare, having a history of gallstones may increase the risk of gallbladder cancer.