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[Natural course of asymptomatic gallstone disease]
Insights
Asymptomatic gallstones (cholelithiasis) rarely cause symptoms or cancer. Routine ultrasound monitoring is recommended for these patients, avoiding unnecessary treatments.
Area of Science:
- Gastroenterology
- Hepatobiliary Medicine
- Medical Diagnostics
Context:
- Cholelithiasis (gallstones) affects a significant patient population.
- Understanding the natural history of asymptomatic gallstones is crucial for clinical management.
- Previous management strategies for asymptomatic gallstones are not well-defined.
Purpose:
- To evaluate the natural history and outcomes of asymptomatic gallstone patients.
- To determine the risk of developing symptoms or complications in individuals with cholelithiasis.
- To assess the efficacy of oral dissolution therapy for gallstones.
Summary:
- A study of 1850 patients with cholelithiasis found 67.7% were asymptomatic.
- Follow-up of 680 asymptomatic patients revealed only 20% developed biliary symptoms over a median of 13.3 years.
- Gallbladder carcinoma occurred in 0.1% of asymptomatic patients; oral dissolution therapy had low success (4.2%) and high recurrence (20%) rates.
Impact:
- Findings suggest that asymptomatic gallstone patients can be managed with conservative follow-up, primarily ultrasound monitoring.
- This approach avoids the low efficacy and high recurrence associated with oral dissolution therapy.
- Recommends biannual ultrasound surveillance for asymptomatic gallstone patients without immediate intervention.
Abstract:
Of 1850 patients with cholelithiasis diagnosed in the past 17 years, 1116 female and 734 male, 598 patients (32.3%) presented with one or more of three major symptoms, i.e., abdominal pain, fever and jaundice, whereas the remainder (67.7%) had none of these symptoms. The proportion of the asymptomatic patients was similar in all age groups, being around 70%. Only 20 per cent of 680 asymptomatic patients, followed for 10 to 17 years (median 13.3 years), developed biliary symptoms. Older patients over 70 years of age had a higher rate of change to the symptomatic group, as compared with younger patients under 70, 29.5% vs. 19.3%, respectively. During this period, carcinoma of the gallbladder developed in one of the asymptomatic patients (0.1%). Oral dissolution therapy was successful in only 4.2 per cent of attempted cases and associated with a recurrence rate of as high as 20%. We conclude that asymptomatic gallstone patients should only be followed up by ultrasound twice a year without any treatment.