Gallstone disease: diagnosis and management

Introduction

Gallstone disease occurs when hard fatty or mineral deposits (gallstones) form in the gallbladder. Approximately 15% of the adult population are thought to have gallstone disease, and most of these people experience no symptoms. For a small proportion of people with gallstone disease, the stones irritate the gallbladder or block part of the biliary system, and this can cause symptoms such as pain, infection and inflammation. If these symptoms are left untreated, gallstones can cause more serious and in some cases life‑threatening conditions such as cholecystitis, cholangitis, pancreatitis and jaundice.

There is variation in how gallstone disease is managed. Some people with symptomless gallstone disease are offered treatment to prevent symptoms developing in the future, whereas others are offered a watch‑and‑wait approach. When people experience symptoms of gallstone disease they often need surgery to remove their gallbladder. There is uncertainty about the best way of treating gallstone disease. In addition, if surgery is appropriate there is uncertainty about whether it should be performed as soon as possible after a gallstones attack or delayed until any infection and inflammation has subsided.

This guideline addresses some of these uncertainties and provides recommendations about how gallstone disease should be identified, diagnosed and managed in adults.