liver and gallbladder disorders
Gallstones
Treatment of Gallstones
Surgery to remove gallbladder (cholecystectomy) Sometimes medications to dissolve gallstones Sometimes gallstone removal via endoscopic retrograde cholangiopancreatography (ERCP) Gallstones that do not cause symptoms (silent gallstones) do not require treatment. If gallstones cause pain, changing the diet (for example, to a low-fat diet) does not help. If gallstones cause disruptive, recurring episodes of pain, a doctor may recommend surgical removal of the gallbladder (cholecystectomy). Removal of the gallbladder prevents episodes of biliary colic yet does not affect digestion. No special dietary restrictions are required after surgery. During cholecystectomy, the doctor may also check for stones in the bile ducts. About 90% of cholecystectomies are done using a viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope is inserted. Surgical tools are passed through the incisions and used to remove the gallbladder. Laparoscopic cholecystectomy has lessened the discomfort after surgery, shortened the length of hospital stays, provided better cosmetic results, and reduced the time needed to recover. The rest of cholecystectomies are done by open abdominal surgery, which requires a larger incision in the abdomen. Alternatively, gallstones can sometimes be dissolved with medications, such as bile acids (ursodeoxycholic acid), taken by mouth. Such a medication can dissolve tiny stones in 6 months. Larger stones may take up to 1 to 2 years. Many never dissolve. Dissolving gallstones with medications is most likely to work when stones are made of cholesterol and the opening of the gallbladder is not blocked. Even if the stones are successfully dissolved, half of these people develop gallstones again within 5 years. This treatment has limited use, and doctors primarily use it when surgery is too risky (for example, in people with major medical problems—see Surgical Risk ). Ursodeoxycholic acid, a medication taken by mouth, can help prevent stones from forming in people with obesity who are losing weight rapidly after weight-loss surgery or who are on a very low calorie diet. Most stones in the bile ducts can be removed during ERCP (see figure). During this procedure, doctors pass an instrument through the endoscope and use it to cut the sphincter of Oddi (which is where the common bile duct connects to the small intestine)—a procedure called endoscopic sphincterotomy. Sometimes the end of the bile duct is also cut and widened. If the stones do not spill out into the small intestine on their own after the cut is made, a catheter with a small basket at its tip is inserted through the endoscope. It can be used to trap and then pull the stone out of the duct. Cutting the end of the bile duct leaves the opening wide enough to let any future stones pass more easily into the small intestine. Gallstones located in the gallbladder cannot be removed using this technique. ERCP with endoscopic sphincterotomy is successful in 90% of people. It is far safer than open abdominal surgery. Fewer than 1% of people die from this procedure, but up to 7% experience complications soon after ERCP with endoscopic sphincterotomy. Such complications include inflammation of the pancreas ( Overview of Pancreatitis ), and less commonly bleeding and perforation or infection of the bile ducts. Later on, in some people, the inflamed bile ducts narrow (called strictures). When the ducts narrow, stones are more likely to form in the ducts, causing more blockages in the ducts. Most people who have had ERCP and endoscopic sphincterotomy later have their gallbladder removed, typically using a laparoscope. If the gallbladder remains, stones in the gallbladder may pass into the ducts, causing repeated blockages. 