Treatments

How are gallstones treated?

If they are not causing any symptoms, then it may not be necessary to have any treatment at all. Even if you have a single attack of pain from gallstones, there may be no further trouble for many years, if ever. This usually means that a single stone has travelled all the way out of the gall bladder, down the bile duct, into the intestine and has been passed naturally, so that in effect the patient has cured himself or herself of the problem. Gallstones are softer than kidney stones, so cannot be got rid of by fragmentation in the same way that kidney stones (which are hard and brittle) can. This means that in order to get rid of them gallstones have to be physically removed. This is usually done in one of two ways. If the gallstones are all contained in the gall bladder, then the simplest method is to have a small operation to remove the gall bladder and the stones within it. These operations can nowadays often be done with keyhole surgery, which means that patients recover from the operation within just a day or two, a huge improvement from the much larger operations that used to be necessary for gallstones in the past. The other way of dealing with gallstones, by endoscopy, is used for stones that have found their way into the common bile duct and caused a blockage there. Such stones can often be treated with ERCP (see below). Occasionally doctors might recommend other sorts of treatment.

Taking bile acids by mouth has largely gone out of vogue because treatment was lengthy, success rates were modest and recurrence of gallstones was frequent. In a very small number of patients, gallstones can be broken up by using shock waves. There is no question that, for most people, surgery is currently the best option for treating gallstones

What happens if I don’t fancy having surgery?

If you have had episodes of pain that your doctor thinks are due to gallstones, it is likely that you will be offered surgery unless you are so unfit that an operation would be too risky. If you do not like the idea of surgery, you might choose to wait and see what happens to you. It is likely you will continue to have bouts of pain but most people with gallstones do not develop other complications. A small number of people will get jaundice but this can usually be readily treated as described above. Rarely, a gallstone can block the pancreas. This leads to a potentially serious complication called acute pancreatitis. If you are going to choose not to have surgery, do ensure that you are aware of the small risk that you are running.

What is ERCP?

ERCP (as it is usually known) means Endoscopic Retrograde Cholangio-Pancreatography, which is a complicated
way of describing a method in which gallstones may be removed with an endoscope so that surgery is unnecessary. A flexible endoscope is passed through the mouth, down to the stomach to reach the opening of the bile duct into the intestine.

A tiny tube is then passed through the endoscope and inserted into the lower end of the bile duct. If dye is squirted through this tube an X-ray picture of the duct can then be taken. The dye is squirted backwards (retrograde) up the duct and produces a picture of the bile duct (a cholangiogram) and also, if required, a picture of the pancreatic duct (pancreatogram), hence ERCP. If the cholangiogram confirms the presence of a stone in the duct this can either be removed or more often the bottom end of the duct can be enlarged so that the stone can pass out naturally. It is also possible to put little drainage tubes (stents) past the stones so that the bile can then, flow freely again.

These and similar techniques have the big advantage that an operation can be avoided, which is particularly useful in older or frailer patients.

Can people manage without a gall bladder?

Yes. If there is no gall bladder, bile just dribbles continuously into the intestine, rather than being reserved purely for after meals, as is the case if the gall bladder is functioning normally. There is no problem with digestion and people do not have any after-effects from their gall bladder having been removed.

What research is needed?

We need to know why gallstones have been becoming more common in recent years. It should then be possible to help to prevent them and their complications in the future. Although keyhole surgery has been a huge advance, like all surgical procedures, there can be complications. Gallstones are such a common problem that we need imaginative researchers to come up with non-surgical methods of treating them.