Asymptomatic gallstone disease

Asymptomatic gallstone is an incidental finding and a diagnosis is made when gallstones are detected in the absence of gallstone related symptoms (biliary pain or gall stone related complications) (1).

• around 10-20% of people in most western countries have gallstones, out of which 50-70% are asymptomatic at the time of diagnosis (1)
• it is estimated that about 10% will have developed symptoms five years after the stones first form (2). In these people, the presence of stones, of which about 10% are radio-opaque, is rarely discovered by incidental imaging for other conditions, e.g. on an intravenous urogram, or more frequently, on an ultrasound scan.

Cholecystectomy in asymptomatic patients is controversial and is usually not advised since the risks of the operation outweigh the complications if the stones are left

• laproscopic cholecystectomy may be carried out in the following group of patients with asymptomatic gallstones
  • patients with chronic haemolytic syndromes (for example, sickle cell disease)
  • patients with immune suppression e.g. after transplantation
  • patients with insulin-dependent diabetes
  • patients with rapid weight loss, weight cyclers and those with higher risks of complications generally
  • patients with calcified 'porcelain' gallbladder as these are also at high risk of evolving into cancer (3)

Reference:

• (1) Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007;52(5):1313-25
• (2) Bellows CF, Berger DH, Crass RA. Management of gallstones. Am Fam Physician. 2005;72(4):637-42
• (3) World Gastroenterology Organisation (WGO). WGO Practice Guideline: Asymptomatic Gallstone Disease