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Review
. 2020 Feb 28;117(9):148-158.
doi: 10.3238/arztebl.2020.0148.

The Treatment of Gallstone Disease

Carsten Gutt  1 , Simon Schläfer, Frank Lammert
Affiliations
Review

The Treatment of Gallstone Disease

Carsten Gutt et al. Dtsch Arztebl Int. .

Abstract

Background: Gallstone disease affects up to 20% of the European population, and cholelithiasis is the most common reason for hospitalization in gastroenterology.

Methods: This review is based on pertinent publications retrieved by a selective search of the literature, including the German clinical practice guidelines on the diagnosis and treatment of gallstones and corresponding guidelines from abroad.

Results: Regular physical activity and an appropriate diet are the most important measures for the prevention of gallstone disease. Transcutaneous ultrasonography is the paramount method of diagnosing gallstones. Endoscopic retrograde cholangiography should only be carried out as part of a planned therapeutic intervention; endosonography beforehand lessens the number of endoscopic retrograde cholangiographies that need to be performed. Cholecystectomy is indicated for patients with symptomatic gallstones or sludge. This should be performed laparoscopically with a four-trocar technique, if possible. Routine perioperative antibiotic prophylaxis is not necessary. Cholecystectomy can be performed in any trimester of pregnancy, if urgently indicated. Acute cholecystitis is an indication for early laparoscopic cholecystectomy within 24 hours of admission to hospital. After successful endoscopic clearance of the biliary pathway, patients who also have cholelithiasis should undergo laparoscopic cholecystectomy within 72 hours.

Conclusion: The timing of treatment for gallstone disease is an essential determinant of therapeutic success.

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Figures

Figure 1
Figure 1
Sonographic appearance of acute cholecystitis in cholelithiasis
Figure 2
Figure 2
Algorithm for the diagnosis and treatment of gallstones. AP, alkaline phosphatase; ALT, alanine aminotransferase; CDL, choledocholithiasis; ERC, endoscopic retrograde cholangiography; EUS, endosonography; GT, glutamyltransferase; MRC, magnetic resonance cholangiography
Figure 3
Figure 3
Intraoperative view of acute cholecystitis
Figure 4
Figure 4
Results of the ACDC Study (8) a) Proportion (%) of patients with relevant comorbidities within the first 75 days after study inclusion: early versus delayed cholecystectomy b) Proportion (%) of ITT patients with ASA score ≤ 2 (healthy or mild systemic disease) or >2 (severe or life-threatening disease) at the end of the study after 75 days ACDC, Acute Cholecystitis: Early Versus Delayed Cholecystectomy; ASA, American Society of Anesthesiologists; CHE, cholecystectomy; ITT, intention to treat; PP, per protocol
See this image and copyright information in PMC

Comment in

References

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