Asymptomatic Gallstones: What We Should Do?

Abstract

Cholelithiasis is common (10-25%) in the general population, with the majority (70-80%) being asymptomatic at the time of diagnosis, and only few (10-20%) produce symptoms or complications in life time. Cholecystectomy, either open or laparoscopic, is straight forward for symptomatic gallstones, unlike the controversies in asymptomatic or silent gallstones. Stones with true biliary ‘colic’ (and not the vague dyspeptic symptoms) are considered symptomatic. Patients on long-term parental nutrition and liver cirrhosis have high prevalence of asymptomatic stone formation. Transient gallbladder sludge or stone formation is common in children treated with high doses of ceftriaxone or in pregnancy. Diabetic patients with asymptomatic stones are no longer considered at being at high risk of developing symptoms or complications. In case of an asymptomatic gallstone together with a common bile duct stone, endoscopic treatment of the ductal stone is sufficient, leaving the gallbladder in situ. Most of the transplant patients with asymptomatic gallstones can safely undergo cholecystectomy when their asymptomatic stone turns symptomatic. On the other hand, good risk patients undergoing abdominal surgery may undergo concomitant cholecystectomy for asymptomatic gallstones. Certain geographical areas with high incidence of cholelithiasis and gallbladder malignancy may have a relaxed policy for cholecystectomy. Except in high-risk groups, most of the studies favor a ‘wait and watch’ policy for asymptomatic gallstones. Aim of this comprehensive review is to analyze the available evidence to help both clinician and patients to make a decision in case of asymptomatic or silent gallstones.