Medical Q&As

Gallstones - alternatives to surgery?

I have just been diagnosed with gallstones. I was wondering if they can be treated without surgery.

It is possible in some cases to remove gallstones in a procedure known as ERCP (endoscopic retrograde cholangiopancreatography). This specialised technique involves the use of x-rays in conjunction with an endoscope. The endoscope is a flexible fiberoptic tube that is also used in the investigation of peptic ulcers. The tube is passed down the throat, down through the oesophagus or gullet, through the stomach and into the duodenum. The doctor is then able to visualise the interior of the duodenum and is able to locate the opening where the bile duct connects with the duodenum. It is then possible to inject a special dye up through the bile duct and the outline of the bile duct system and gallbladder is visualised by x-ray. Gallstones can also be identified and located with this technique. ERCP is generally only suitable for solitary stones. Depending on the size and location of the gallstone it may then be possible to remove it with a special instrument that can be passed up the bile duct. When the instrument is withdrawn it also removes the stone. Another alternative to surgery is to dissolve the gallstones chemically. However, this therapy is only suitable for small gallstones that are composed of cholesterol. Ongoing research is taking place with regard to disintegrating gallstones in a technique known as lithotripsy. This is similar to the technique that is employed in treating kidney stones, which involves the use of sound waves to shatter the stones within the kidney. In summary, there are a number of alternatives to surgery but these treatments are only suitable for a minority of people in very particular circumstances. There is the added consideration that gallstones can recur and this has been shown to occur in up to 50% of people who have been treated non-surgically.