[Diagnosis and treatment of cholelithiasis]

Abstract

Most patients with gallbladder stones are asymptomatic and do not require treatment. Biliary colics are the main indication for laparoscopic cholecystectomy: the treatment of choice for gallbladder stones. Dyspepsia is not an indication for treatment of gallstones. The indications for bile salt therapy and extracorporeal lithotripsy are limited. Acute cholecystitis should be treated with cholecystectomy à chaud whereas longstanding cholecystitis is preferably treated with cholecystectomy à froid. Bile duct stones are mainly treated endoscopically during endoscopic retrograde cholangiopancreatography (ERCP): pancreatitis, bleeding and perforation are the main complications. Prior to cholecystectomy, an ERCP is indicated in case of cholangitis, severe pancreatitis, persisting jaundice, bile duct stones on ultrasonography, or the combination of dilated ducts and abnormal liver function tests. After endoscopic stone removal, a cholecystectomy is indicated for patients < 50 years but a 'wait and see' policy is justified in elderly patients.