Clinical Review Clinical Review

Gallstones

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39267.452257.AD (Published 09 August 2007) Cite this as: BMJ 2007;335:295
  1. Grant Sanders, locum consultant laparoscopic upper gastrointestinal surgeon,
  2. Andrew N Kingsnorth, professor of surgery at Peninsula Medical School
  1. Department of Upper Gastrointestinal Surgery, Derriford Hospital, Plymouth PL6 8DH
  1. Correspondence to: G Sanders gsanders{at}doctors.org.uk

    Summary points

    • • Of the adult Western population, 10-15% will develop gallstones, with between 1% and 4% a year developing symptoms

    • • The incidence of gallstones increases with age, with family history being an important risk factor

    • • People with asymptomatic gallstones develop gallstone related problems at a rate of 1%-4% a year, with small stones being more dangerous than large as they can cause pancreatitis

    • • Ursodeoxycholic acid does not reduce symptoms from gallstones but may be useful in preventing their formation in high risk groups

    • • Percutaneous cholecystostomy is a good treatment for patients at high surgical risk

    • • Day case laparoscopic cholecystectomy should be the default for elective procedures.

    • • Cholecystectomy should be performed on the index admission for biliary symptoms

    About 10-15% of the adult Western population will develop gallstones, with between 1% and 4% a year developing symptoms.1 From April 2005 to March 2006, 49 077 cholecystectomy procedures took place in England,2 a 10th of the number of procedures in the United States.3

    The management of gallstone disease is changing rapidly, with an increase in day case surgery and in cholecystectomy during the index admission for cholecystitis and with the advent of natural orifice transluminal endoscopic surgery.

    This review focuses on the problems that gallstones cause and their optimal treatment based on current evidence.

    Who gets gallstones?

    Gallstones occur when there is an imbalance in the chemical constituents of bile that results in precipitation of one or more of the components. Why this occurs is unclear, although certain risk factors are known.

    Gallstones are seen in all age groups but the incidence increases with age.4 The old adage “fat and fertile, female and forty” tells only part of the story. Oestrogen does cause more cholesterol to be excreted into bile, and obesity (body mass index >30) is …

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