[Prevention of recurrence after successful gallstone dissolution]

Gallstone recurrence is a major problem in the medical treatment of gallstones (treatment with UDCA/CDCA, ESWL, local MTBE lysis). The probability of gallstone recurrence is higher in subjects with multiple stones before dissolution treatment and in older subjects (greater than 50 years). The present knowledge on factors predictive of gallstone recurrence and the results of clinical trials for preventing recurrence are given. The different effects of diet and drugs on cholesterol saturation of bile, on nucleation of bile, on mucus production of gallbladder and on gallbladder contractility are discussed and recommendations for a rational approach for prevention of gallstone recurrence are given. Preventable risk factors for gallstone disease have to be eliminated. In general, continuous post-dissolution treatment seems not justified. Regular follow-up ultrasound examinations should be started to detect renewed of gallstones at an early stage.