0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Treatment of Gallstones

David F. Ransohoff, MD; and William A. Gracie, MD
[+] Article and Author Information

From the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and the University of Michigan, Ann Arbor, Michigan. Requests for Reprints: David F. Ransohoff, MD, CB# 7105, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7105.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(7_Part_1):606-619. doi:10.7326/0003-4819-119-7_Part_1-199310010-00010
Text Size: A A A

Purpose: To critically review the risks and benefits of therapy for asymptomatic and symptomatic persons with gallstones who are considering therapy to prevent future episodes of biliary pain or complications including acute cholecystitis, pancreatitis, or gallbladder cancer.

Data Sources: Review of English-language literature regarding the natural history of persons with gallstones and the operative mortality rates for open cholecystectomy and laparoscopic cholecystectomy. Mathematical simulation modeling was used to derive estimates of lifetime risks for gallstone-related mortality and for life expectancy, for prophylactic cholecystectomy and expectant management, for men and women of different ages.

Results: For persons with asymptomatic gallstones, natural history is so benign that treatment is generally not recommended. For persons with symptomatic gallstones, (that is, that have caused an episode of biliary pain), the rate for subsequent pain is high so that many persons probably choose cholecystectomy to avoid pain; however, about 30% of persons who have had pain do not have further episodes of pain. The expected loss of life for persons with symptomatic stones managed expectantly is roughly several months, on average, and may not be considered high enough in itself to warrant therapy. Although laparoscopic cholecystectomy has become popular with patients and physicians, its safety is yet unknown compared with open cholecystectomy.

Conclusion: Prophylactic cholecystectomy should be recommended for most persons with symptomatic gallstones unless the person wants to try a period of watchful waiting to see if pain recurs. Nonsurgical therapy may be suitable for persons with high operative risk. For persons with asymptomatic gallstones, watchful waiting is the best course.

Figures

Grahic Jump Location
Figure 1.
The model can be represented as a Markov state problem with several states.

For calculations in the simulation model, persons with asymptomatic gallstones could have transitions marked A; persons with symptomatic gallstones could have transitions marked S. For details, see text.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)