Non-surgical treatments of gallstones involve the oral administration of drugs that are able to dissolve gallstones, the administration of cholesterol-lowering drugs, and drugs that lower the intestinal absorption of cholesterol. While the surgical treatments involve the removal of the gallbladder either with open surgery or laparoscopy.
- Gallstones are commonly asymptomatic and no treatments are required.
- Symptomatic gallstones with or without complications are important to be treated.
- Non-surgical treatment is recommended for a patient with mild symptoms.
- Non-surgical treatment of gallstones is established for cholesterol gallstones only while no treatments to dissolve pigment stones or calcified stones.
- The non-surgical treatment of gallstones involves oral administration of medications that dissolve gallstones such as Ursodeoxycholic acid or/and medications that lower the intestinal absorption of cholesterol.
- Laparoscopic cholecystectomy is considered the gold standard treatment for gallstones.
Although gallstones are commonly asymptomatic and no treatment is generally required, It is important to treat symptomatic gallstones with or without complicated conditions.
The treatment of gallstone disease occurs on the basis of :
- The presence or absence of symptoms, the presence or absence of complications, and the function of the gallbladder.
- The composition and size of gallstones.
- It is not routinely recommended to treat patients with asymptomatic gallstones (Ref)
- Approximately 60%-80% of patients with gallstones are completely asymptomatic (Ref).
Treatments of gallstones involve two main options:
- Non-surgical treatment involves the dissolution of gallstones without surgery
- Surgical treatment involves the surgical removal of the gallbladder (cholecystectomy)
Non-surgical treatment of gallstone diseases:
The non-surgical treatment of gallstones is currently restricted to patients with mild symptoms or with small cholesterol gallstones in a functioning gallbladder.
Actually, there is no established medical therapy for the dissolving of pigment stones or calcified stones of any type (Ref). In contrast, for cholesterol stones, there are oral medications that help in dissolving this type of stone.
A careful selection of patients may lead to successful non-surgical therapy in symptomatic patients with a functioning gallbladder containing small stones.
However, the non-surgical treatment of gallstones has a disadvantage of a high rate of the recurrence of gallstones. Recurrence occurs in 25 % of patients within five years after treatment.
Non-surgical treatment includes the following:
Oral dissolution therapy
The non-surgical treatment of gallstone diseases involves using oral medications with hydrophilic bile acid as an oral dissolution therapy for dissolving gallstones.
These include the usage of Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid, which are effective and tolerated for the treatment of gallstones (Ref).
- Ursodeoxycholic acid (UDCA) used in a dose of 10-14 mg/kg per day, increases its accumulation in the bile acid pool, hence, decreasing the hepatic secretion of biliary cholesterol and the formation of unsaturated gallbladder bile. The net result is the dissolution of cholesterol gallstones.
- Also, UDCA reduces the intestinal absorption of cholesterol (Ref).
- Moreover, it improves postprandial gallbladder emptying by enhancing smooth muscle contractility (Ref).
A study showed that 6 months of administration of Ursodeoxycholic acid (UDCA) lead to a complete disappearance of stones with a diameter of less than 5 mm in about 90% of cases. However, the chance of stone dissolution by UDCA decreased with patients having larger or multiple gallstones.
The administration of Ursodeoxycholic acid (UDCA) is recommended to be at bedtime. since it maintains the hepatic bile acid secretion rate overnight, thus reducing the secretion of supersaturated bile and increasing the dissolution rate of gallstones.
In case of biliary colic symptoms, they are treated with pethidine which is given in combination with an antispasmodic agent like atropine or glycopyrronium.
In case of acute biliary colic pain, treatment with NSAIDs (nonsteroidal anti-inflammatory drugs) and anti-spasmodic drugs like scopolamine is recommended.
Statins are drugs that inhibit the formation of cholesterol and could influence the formation of cholesterol gallstones. Also, they could help in the dissolution of gallstones.
A study published in the Journal of the National Library of Medicine reported that the long-term use of statins (1 to 1.5 years) was associated with a decreased risk of gallstones followed by cholecystectomy, compared with patients without statin use
Ezetimibe is a cholesterol-lowering agent. It is used to treat patients with high blood cholesterol levels.
It prevents the intestinal absorption of cholesterol thus, it lower biliary cholesterol secretion and saturation.
Also, It might act as a new tool in treating and/ or preventing cholesterol gallstones
Ezetimibe is recommended in case you are not allowed to take statins or in case statins don’t work for you.
Ezetimibe is available under the brand name Ezetrol. It could lower your cholesterol levels within 2 weeks.
The main side effect of ezetimibe is the intestinal pain and diarrhea.
Surgical treatment of gallstones:
Cholecystectomy means the removal of the gallbladder with its gallstones.
Surgical treatment is the primary procedure for symptomatic gallstones.
It shows a low risk of recurrence and provides relief of pain in 92% of patients.
There are two types of cholecystectomy (Ref)
Open surgery which involves 1 incision (4-6 inches) in the upper right-hand side of your belly.
The gallbladder is removed through this incision.
This method involves 3-4 small incisions.
It is performed using a long and thin laparoscopic tube which has a very small video camera and surgical tools.
The laparoscopic tube enters through the incisions and the gallbladder is removed while looking through a TV monitor.
This method is safe, less invasive, with less bleeding. Therefore, recovery occurs rapidly compared with the traditional method.
Laparoscopic cholecystectomy is much better than open cholecystectomy due to a low mortality rate, less pain, and fewer day of hospitalization.
For patients suffering from the complications of gallstones, a prophylactic treatment along with laparoscopic cholecystectomy is recommended (Ref)