Clinical Review

Gallstones

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2669 (Published 22 April 2014) Cite this as: BMJ 2014;348:g2669
  1. Kurinchi S Gurusamy, lecturer,
  2. Brian R Davidson, professor of hepatopancreatobiliary and liver transplantation surgery
  1. 1Department of Surgery, 9th floor Royal Free Hospital, Royal Free Campus, UCL Medical School, London, UK
  1. Correspondence to: K Gurusamy k.gurusamy{at}ucl.ac.uk

Summary points

  • Gallstones are common in adults

  • Currently, treatment is indicated only for symptomatic gallstones

  • Pain is the most common symptom related to gallstones

  • Occasionally gallstones present with life threatening complications

  • Surgery is the only definitive treatment and is recommended for people with symptomatic gallstones who are fit to undergo surgery

  • Laparoscopic cholecystectomy is currently the preferred method of surgery and is generally both effective and safe; however, there is a 0.3% risk of serious injury to the bile duct, which may have serious long term consequences

Gallstones affect approximately 5-25% of adults in the Western world. It is therefore important to understand the consequences of a diagnosis of gallstones, the associated complications, and treatment to allow patients to be appropriately advised. The purpose of this review is to update clinicians on the diagnosis and management of gallstones.

Sources and selection criteria

We searched Medline, Embase, the Cochrane Database of Systematic Reviews, and Clinical Evidence online using the search terms “gallstones” or “cholelithiasis”, focusing mainly on systematic reviews, meta-analyses, and high quality randomised controlled trials published within the past five years, wherever appropriate and possible.

What are gallstones?

Gallstones are crystalline deposits in the gallbladder (figure).1 The prevalence of gallstones varies between 5% and 25%, with a higher prevalence in Western countries, women, and older age group.2 Traditionally, gallstones were classified as cholesterol stones, pigment stones, or mixed stones (a combination of cholesterol and pigment stones) based on their composition,3 which can only be determined reliably after their removal.4 Recently, additional types of gallstones have been identified based on their microscopic structure and composition.1 However, most stones fall under the umbrella of cholesterol (37-86%), pigment (2-27%), calcium (1-17%), or mixed (4-16%).1 4 The types of gallstone vary by their cause, the measures attempted to prevent their formation, their appearance on radiographs, …

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