[Gallstones--natural history and conservative management]

Gallstones have a very high prevalence affecting 9.5 and 19.5% of men and women, respectively. The pathophysiology and risk factors for cholesterol gallstones are considered. Modern imaging techniques, in particular ultrasound, are very sensitive to detect cholecystolithiasis, while ERCP remains the gold standard to detect choledocholithiasis. ERCP could be supplanted soon by endosonography and MRCP. Biliary scintigraphy is useful to detect a 'vésicule exclue' and to document gallbladder/sphincter Oddi dysfunction. The different conservative management strategies including litholytic treatment with ursodeoxycholate and lithotripsy have been largely abandoned in favor of laparoscopic cholecystectomy. Litholytic treatment has still a role to play in the prevention of gallstone formation in patients with rapid weight loss and in the newly detected MDR3 defect associated with sludge formation. Biliary colic is treated with non-steroidal analgesic drugs, analgesics and/or spasmolytic agents.