Treatment of Gallstones

General Management

The American College of Physicians recommends that symptomatic gallstones, regardless of composition, require laparoscopic cholecystectomy, which has a >97% success rate and is the gold standard treatment 1, 2
Asymptomatic gallstones, regardless of composition, should be managed expectantly due to their benign natural history and low complication risk, as suggested by the American College of Physicians 3, 4, 1

Oral bile acid therapy is effective only for cholesterol-rich stones that are small (<5-6 mm diameter), radiolucent, and floating on oral cholecystography, with a patent cystic duct, as recommended by the American Gastroenterological Association 1, 2
Extracorporeal shock-wave lithotripsy with adjuvant bile acids works for solitary radiolucent cholesterol stones <2 cm, with a success rate of ~80% for single stones and 40% for multiple stones, according to the American Gastroenterological Association 1, 2

The American College of Surgeons suggests that asymptomatic patients should be managed expectantly, while symptomatic patients should proceed to assess surgical candidacy 3, 4, 1
Surgical candidates should undergo laparoscopic cholecystectomy, while poor surgical candidates or those who refuse surgery should consider non-surgical options, as recommended by the Society of American Gastrointestinal and Endoscopic Surgeons 1, 5, 2

The American Gastroenterological Association notes that brown stones in the common bile duct require ERCP with sphincterotomy for extraction, followed by cholecystectomy if gallbladder stones remain 1, 2
Non-surgical therapies do not prevent gallbladder cancer, and recurrence after successful dissolution occurs in ~50% of patients, highlighting the importance of cholecystectomy, as stated by the American College of Physicians 1