Patient decision-making in symptomatic gallbladder disease

One in five people with gallstones develop symptoms (~ 13 million in the US), yet only a fraction undergo cholecystectomy. The frequency of and factors associated with patients choosing medical management for gallbladder disease are not well understood. The goal of this study was to assess patient decision-making regarding cholecystectomy, experiences with medical management, and interest in a clinical trial comparing cholecystectomy with medical management.

We conducted a cross-sectional survey from January 2020 through May 2020 using Amazon's crowdsourcing platform, MTurk. After a brief screening survey to determine gallbladder disease history and cholecystectomy status, eligible users without prior cholecystectomy were invited to complete the full survey for US $2.50.

There were 148 responses included in analysis (93.7% of attempted). Participants were 54% female with a mean age of 36.2 (SD 11.3) years. 36% of participants had used medications or supplements to manage their symptoms with 17% using lecithin and 22% using ursodeoxycholic acid (Ursodiol®). 85% attempted lifestyle modifications to manage symptoms. Surgery was recommended for 60% of which 43% reported planning cholecystectomy. Among those recommended operation, most common reasons for pursuing were symptoms (50%) and symptoms interfering with care of family (42%), while most common reasons for not pursuing were risks of surgery/anesthesia (56%), ongoing medical management (50%), and symptom tolerance (38%). 67% reported willingness to participate in a clinical trial comparing medical management to cholecystectomy.

A significant portion of patients with symptomatic gallbladder disease choose not to undergo cholecystectomy. One of the most common reasons for avoiding surgery was the use of alternative therapies, despite limited evidence to support their use. The lack of prospective comparison of cholecystectomy to medical therapies for the management of gallbladder disease, along with patient interest, support the need for a clinical trial.