Current options for the management of gallstones

Approximately 20% of the Australian population will develop gallstones. On current evidence, patients with asymptomatic gallstones should be treated expectantly. Cholecystectomy remains the therapy of choice for patients with symptomatic or complicated gallstones. In recent years a number of non-surgical treatments have become available for the management of gallstones, the most exciting of which is extracorporeal shock wave lithotripsy (ESWL), which is now available in Australia. Approximately 20% of patients with symptomatic gallstones are suitable for ESWL. Dissolution of gallstones with long-term oral bile acid therapy may be appropriate for a small group of patients. Gallstones may also be dissolved by the direct application, via a percutaneously placed stent, of the dissolving agent, methyl tert-butyl ether; this therapy is currently experimental, but it may provide an alternative to surgery in selected patients.