Gallstone Disease Treatment | Johns Hopkins Medicine

If you experience symptomatic gallstones, there are a number of different treatment options available. Your exact course of treatment will depend on your symptoms and the characteristics of the gallstones you have. The goal of treatment is to relieve symptoms and prevent complications from developing. Treatment for gallstones includes:

• Medication
• Surgery
• Extracorporeal shock wave lithotripsy
• Percutaneous therapy
• Endoscopic gallbladder stenting
• Treating complications of gallstones

Gallstone Disease Treatment: Medication

There are several medications available for symptomatic gallstones, which are designed to:

• Interfere with the development of gallstones in the gallbladder
• Dissolve the stones

These medications are only useful in patients who have small, non-calcified cholesterol stones and whose gallbladder is functioning normally. Therapy takes at least six to 12 months. There is a chance that the gallstones will recur within five years.

Gallstone Disease Treatment: Surgery

Cholecystectomy is surgery to remove your gallbladder. It is the only treatment option to cure symptomatic gallstones. Laparoscopic cholecystectomy is the most common procedure instead of a traditional, open procedure. During a laparoscopic cholecystectomy, your surgeon:

• Makes a few small incisions in your abdomen rather than one large one
• Inserts a miniature video camera and laparoscopic instruments into the incision
• Removes the gallbladder and closes the incisions with stitches

Advantages of a laparoscopic procedure include:

• Less pain
• Shorter hospital stay
• Faster return to normal activities

Sometimes, a surgeon begins the procedure using a laparoscopic approach but then switches to an open approach because of scarring, infection or other complications. No matter which approach your doctor uses, he or she has your best possible outcome in mind.

Gallstone Disease Treatment: Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a nonsurgical alternative to manage gallstones. You can receive this treatment as long as your gallbladder is functioning normally and your stones are small.

You do not need anesthesia for ESWL, and the procedure may be performed as an outpatient. This method uses high-energy sound waves to produce shock waves. The shock waves are strong enough to fracture and disintegrate the gallstones.

Patients who cannot undergo surgery may be good candidates for ESWL.

Gallstone Disease Treatment: Percutaneous Therapy

In certain high-risk patients, surgery may be too dangerous. A percutaneous (through the skin) treatment approach may be used. During this procedure, your doctor opens the gallbladder, dilates the tract and removes any gallstones using a device called a cholecystoscope.

Another percutaneous method is called contact dissolution therapy. During this procedure, a catheter is inserted into your gallbladder, and a solvent is injected directly to the gallbladder. The solvent dissolves the cholesterol stones.

Gallbladder Disease Treatment: Endoscopic Gallbladder Stenting

Endoscopic gallbladder stenting is another nonsurgical approach to treat gallstones. It is useful in treating high-risk patients who cannot undergo surgery, usually due to an illness. During this procedure, your doctor performs an ERCP and inserts a stent from the gallbladder to the duodenum. The stent relieves biliary symptoms and complications.

Treating Complications of Gallbladder Disease

Certain complications may arise in patients with gallbladder disease. Your doctor will discuss with you the risks of complications.

• Acute cholecystitis: This is the most common complication, and it occurs when the gallstone becomes impacted in the cystic duct. The bile is then trapped in the gallbladder, causing damage and inflammation. Usually, a cholecystectomy (removal of the gallbladder) is the best treatment.
• Choledocholithiasis: This occurs when gallstones become displaced to the common bile duct rather than to the gallbladder. Choledocholithiasis can cause life-threatening conditions. An ERCP can be performed to diagnose and treat these gallstones.

Less common complications include:

• Cholecystoenteric fistulas, which form when a large stone erodes through the gallbladder into the bowel. Treatment involves cholecystectomy and bowel resection.
• Mirizzi’s syndrome is the result of a gallstone blocking the cystic duct, compressing the common bile duct and causing inflammation. ERCP is used to diagnose and treat it.
• Porcelain gallbladder occurs when the gallbladder wall calcifies (hardens), usually because of gallstones. This can lead to gallbladder cancer, so removal of the gallbladder is recommended.

Non-Surgical Gallstone Removal – Cholangioscopy Technique

Gallstones can cause pain that is usually on the right side or middle of your upper belly, may be constant or worse after a heavy meal, may sometimes feel more like fullness than pain, may be felt in your back and in the tip of your right shoulder blade. Other symptoms may include nausea, vomiting, fever, and chills. The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.

Non-Surgical Gallstone Removal

Percutaneous endoscopic procedure is a technique that can be used to treat patient that have gallstones, known as cholelithiasis, but cannot undergo surgery for gallbladder removal due to other medical issues. Often times these patients end up with a gallbladder drain, a cholecystostomy tube, that cannot be removed because of the risk of recurrent pain and symptoms.

There may also be stones in the bile ducts, known as choledocholithiasis.

This procedure is performed by our trained interventional radiologists, a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions without surgery. Our interventional radiologist using direct visualization with a camera and X-ray guidance from a fluoroscopy machine that allows for control of the instruments used to remove the stones.

Non-Surgical Gallstone Removal and Choledoscopy Candidate

Endoscopic gallstone removal is typically for patients who are too old or high risk to have traditional gallbladder surgery or who have bile duct stones that cannot be removed in the standard fashion. Sometimes this treatment can be offered to patient who have strong medical, religious or personal reasons for not wanting their gallbladder removed.

If you have had a gallbladder drain placed for gallstones but cannot get your gallbladder surgically removed, then you are potentially a candidate for this procedure.

Our specialist has treated a number of patients who are over 80 years old and too sick to undergo surgery. The lower risk profile makes this an ideal procedure for older patients or those with a number of medical issues to undergo surgery. Since this procedure can be performed with twilight sedation, this also eliminates the risks of general anesthesia and intubation. This is a safe and effective procedure when performed by our experienced interventional radiologist with an understanding of the techniques needed to reduce complications.

Success Rate of Non-Surgical Gallstone Removal Cholangioscopy

Endoscopic and fluoroscopic-guided gallstone removal is highly successful, with complete stone removal from the gallbladder or bile ducts occurring in 80% of cases. This has a significant impact on patients and their family who are left to care for the drainage catheter, which would be otherwise for the rest of the patient’s life. After the procedure, the catheter can be removed allowing the patient to have a better quality of life.

Non-Surgical Gallstone Removal Procedure

Percutaneous endoscopy is performed through the existing gallbladder drain tract. If you don’t have a gallbladder drain, this will need to be placed.

After 4-6 weeks a tract will form around the gallbladder drain, this is required to prevent any leakage of stones or bile into the abdomen. Once it is confirmed that there is a formed tract, the endoscopic procedure can then be schedule.

Sometimes the size of the drainage catheter is increased prior to removal of the stones so that the tract is larger to accommodate the camera. This depends on the size of the stones.

On the day of the procedure, the drain is exchanged for a larger temporary access into the gallbladder that will fit the endoscopic camera. Iodinated contrast material maybe injected into the bile d

ucts to locate gallstones that maybe causing blockage.  Small stones are

removed using a basket that fits through the camera. Other stones can be washed out by irrigating the gallbladder with saline or water.

Larger stones can be fragmented under endoscopic guidance with a precisely directed holmium laser. The gallbladder is filled with sterile water prior to fragmentation as the laser beam is absorbed by water, preventing damage to the gallbladder wall.

On average, it takes two sessions to clear patients of their stones if there is a large stone burden. After the stones are removed, the tube will stay in place for a couple of weeks to ensure the gallbladder/bile system is still intact and functioning normally. Once this is confirmed, the tube is then removed. The tract heals and closes on its own and does not require any suture or surgery.

How to Prepare for Non-Surgical Gallstone Removal Procedure

Prior to the Procedure

You may not eat or drink eight hours prior to the procedure.

If you are on blood-thinning medication, ask your provider if you need to stop it prior to the procedure.

During the Procedure

You will be asked to change into a gown before the procedure.

Labs maybe obtained.

You will be given a sedative by the anesthesia nurse, who will be present to monitor your vital signs during the examination. Typically the procedure is done with a “twilight sedation.”

After the Procedure

This is an outpatient procedure and does not require hospital stay.

You will remain in a recovery room until most of the effect of the sedative has worn off.

Because of sedation used during the procedure, you’ll need to make plans to have someone take you home.

What are the Risks?

Discomfort at the insertion site

Infection

Nausea

Bleeding

Bile duct or gallbladder injuries like perforation

Results:

We have successfully treated many patients with complete removal of the gallstones. This has rendered them tube free, which is a huge relief for patients and their family.

ᐈ Treatment of gallstones without surgery

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Methods of treatment of gallstones in the gallbladder without surgery The development of pathology is due to a violation of the circulation of bile fatty acids between the liver and the gastrointestinal tract, associated with poor metabolism. These processes lead to crystallization of bile, subsequent precipitation and formation of stones.

In most cases, people are not aware of the presence of stones until an ultrasound scan or biliary colic attacks occur. When symptoms of the disease occur, patients are in no hurry to consult a doctor, because they are afraid of surgical intervention. We hasten to reassure you: modern medicine knows how to dissolve gallstones without surgery in a conservative way. In our article we will talk about the methods used and their features.

GSD may be asymptomatic or present with signs of biliary colic and acute cholecystitis. Patients who have an asymptomatic course of the disease and small calculi are detected should regularly undergo ultrasound and be observed by a gastroenterologist.

Removal of stones from the gallbladder without surgery is indicated in the following cases:

• No complications;
• Stones less than 2 cm in diameter;
• The duration of the calculus in the cavity of the gallbladder is not more than 2 years;
• The cavity of the gallbladder is filled with stones no more than 1/3.

To begin with, the specialist prescribes a diet that excludes spicy, fatty, fried and cholesterol-free foods, as well as alcohol and carbonated drinks. The menu includes only healthy products that are easily absorbed by the body. In case of exacerbation, the patient is shown a 3-day fast and subsequent fractional meals 5-6 times a day. It is advisable to eat according to the established schedule.

We are often asked whether it is possible to get rid of gallstones without surgery using drugs. Yes, the following medicines are used:

• Cholinolytics and antispasmodics to relieve duct spasm and free bile excretion;
• Ursodeoxycholic acid to help dissolve stones;
• With the development of cholecystitis – antibacterial agents with probiotics, enzymes and anthracites.

Along with diet and medication, the patient should lead an active lifestyle and exercise therapy. The combination of a proper lifestyle, diet and drug therapy helps to avoid attacks of hepatic colic and complications of cholelithiasis.

With calculous cholecystitis, accompanied by attacks of biliary colic and thickening of the walls of the gallbladder, the treatment of gallstone disease without surgery will be ineffective. In this case, cholecystectomy is indicated.

Surgeons of the medical center “Concilium Medical” perform surgery using the laparoscopic method, which is considered the least traumatic and the safest. But even after this operation, the patient must follow a diet and be observed by a gastroenterologist.

Gallbladder stones – treatment of gallstone disease

Rare health problems fall on a person immediately in full – much more often they form gradually, imperceptibly. So gallstone disease (cholithiasis) at an early stage is asymptomatic. Sometimes stones of even a large volume do not cause any pain for years and are detected, one might say, absolutely by chance – during an X-ray examination or during an ultrasound of the abdominal cavity.

Gallstone disease manifests itself when an inflammatory process, inevitable in this case, develops in the gallbladder, that is, calculous cholecystitis develops. Typical symptoms of this disease are periodic bouts of pain in the right hypochondrium, bouts of nausea, a feeling of bitterness in the mouth.

Cholithiasis can also unpleasantly make itself felt when there is a blockage of the gallbladder with a stone. It causes an attack of biliary colic – severe pain in the right hypochondrium, which can be given to the right shoulder and shoulder blade. As a rule, pain appears after eating and may be accompanied by nausea and vomiting.

It is impossible to categorically try to endure the pain and postpone a visit to a gastroenterologist in such situations. Gallstone disease has a tendency to severe complications that carry the threat of serious disability and even death.

Diagnosis of cholelithiasis

Ultrasound examination of organs of the abdominal cavity is the main method for diagnosing cholelithiasis. With the help of ultrasound, the very fact of the presence of stones in the gallbladder is revealed, their number, composition is determined, the shape and size of the gallbladder, the degree of deformation of its walls, the condition of the bile ducts are assessed.

General and biochemical analysis of blood reveal signs of inflammation characteristic of the disease.

During the examination, concomitant diseases are also identified, the individual characteristics of the patient’s body are determined, which makes it possible for the doctor to prescribe the optimal course of treatment.

Treatment options for gallstone disease

Conservative therapy

In some cases, gallstones can be eliminated with medications (the so-called litholytic therapy using chenodeoxycholic or ursodeoxycholic acids). But this is real only in the case when the calculi consist mainly of cholesterol. In this case, the stones should be small in size – no more than 15-20 mm in diameter. So litholysis (dissolution of stones) is applicable only in 20% of cases of cholelithiasis. However, in the future, the vast majority of patients relapse – the stones form again. Thus, conservative treatment of cholelithiasis is ineffective.

Lithotripsy

With the advent of special equipment in the arsenal of doctors in the 1980s – shock wave lithotripters – the possibilities of non-surgical treatment of cholelithiasis expanded. However, extracorporeal shock wave lithotripsy (ESWL) is rarely used.

Firstly, it has many contraindications – gastroduodenal ulcers, acute pancreatitis, cysts, vascular aneurysms in the affected area, coagulopathy, etc. Secondly, ESWL has a number of potentially dangerous side effects. Under the influence of waves, fragmentation of stones into parts occurs, and the resulting fragments begin to exit through the common bile duct.