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Nonsurgical management of cholelithiasis
1Department of Medicine, St Vincent's Medical Center of Richmond, Staten Island, NY 10310.
Archives of Internal Medicine
|May 1, 1990
Summary
Cholecystectomy remains effective for gallstones, but new therapies like oral dissolution and lithotripsy offer alternatives. Understanding gallstone characteristics is key to choosing the best treatment.
Area of Science:
- Gastroenterology
- Hepatobiliary Medicine
Background:
- Cholecystectomy is the established treatment for symptomatic gallstones.
- Historically, it was the sole therapeutic option for gallstone management.
Purpose of the Study:
- To review alternative therapies for gallstone treatment.
- To discuss the epidemiology, pathogenesis, natural history, and imaging of gallstones relevant to therapy selection.
Main Methods:
- Review of alternative gallstone treatments: oral dissolution therapy (ursodeoxycholic acid, chenodeoxycholic acid), extracorporeal shock wave lithotripsy, and gallbladder methyl tert-butyl ether instillation.
- Analysis of gallstone characteristics influencing treatment choice.
Main Results:
- Surgical cholecystectomy is a proven therapy for symptomatic cholelithiasis.
- Emerging non-surgical options include oral dissolution, lithotripsy, and direct gallbladder instillation of solvents.
Conclusions:
- The choice of gallstone therapy should be individualized based on patient factors and gallstone characteristics.
- A comprehensive understanding of gallstone disease is essential for selecting appropriate interventions.