REPEATED BILE-ACID THERAPY FOR THE LONG-TERM MANAGEMENT OF CHOLESTEROL GALLSTONES

Background/Aims: Following non-surgical treatment, cholesterol gallsto nes recur in a high proportion of patients, and recurrence cannot be p redicted nor effectively prevented, Our aim was to test prospectively the viability and the efficacy of repeated bile acid therapy, in which recurrent stones are diagnosed at an early stage by regular ultrasoun d monitoring and promptly retreated, as a strategy for the management of these patients in clinical practice, Methods: One hundred and seven ty-two consecutive patients were recruited upon achieving complete gal lstone dissolution using non-surgical therapy (bile acids or lithotrip sy plus bile acids), and followed up at 6-monthly intervals by ultraso und scan, Gallstone recurrence was promptly treated by a combination o f ursodeoxycholic acid plus chenodeoxycholic acid (5 mg/kg per day eac h) for a period of 2 years, or less if complete redissolution was achi eved, Median follow-up period was 34 months (range 6-70). Results: For ty-five patients had gallstone recurrence; of these, 39 underwent one or more repeated courses of bile acid therapy (follow-up data availabl e in 27), Gallstone recurrence rate was 15% at 1 year and 47% at 5 yea rs, Average annual redissolution rate of recurrent gallstones (intenti on to treat) was 41%, The proportion of gallstone-free patients in the whole population was 88%, 84%, 77%, 78%, 75% at 1-5 years, respective ly, and rose to >90% at 3 years onwards in patients with single primar y stones, Conclusions: We conclude that repeated bile acid therapy mai ntains the majority of patients gallstone free, and is therefore an ef fective long-term management strategy, especially in patients with pri mary single gallstones.