Approach to the Diagnosis and Management of Gallstones

Abstract

Gallstones are relatively common in the general population, and the clinical presentation is asymptomatic in most patients or has a benign course, such as biliary colic or vague gastrointestinal symptoms. On the other hand, it sometimes causes life-threatening complications, such as cholecystitis and pancreatitis. Asymptomatic gallstones do not require specific treatment, but a cholecystectomy may be necessary if the patient has a high risk of complications or gallbladder cancer. Abdominal ultrasonography is the most useful diagnostic tool for gallstones, which shows high sensitivity and specificity. In addition, endoscopic ultrasonography may be helpful when typical symptoms of gallstones are present, but gallstones are not identified with abdominal ultrasonography. Abdominal CT, MRCP, or ERCP help identify complications or other accompanying diseases caused by gallstones. Oral bile acid dissolution therapy can be attempted by administering ursodeoxycholic acid and chenodeoxycholic acid if gallstones are confirmed, but the related symptoms are mild or atypical, and the patient is unable/unwilling to undergo a cholecystectomy. A high success rate can be achieved when the treatment candidate is appropriately selected. The disadvantages of oral bile acid dissolution therapy are that there are few appropriate candidates, long-term treatment is required, and the gallstone frequently recurs when the treatment is discontinued.