CURRENT OPTIONS IN GALLSTONE MANAGEMENT - WHAT TO DO WHEN SYMPTOMS ARE MILD OR ABSENT

Recent advance in our understanding of the natural history of gallston es and the introduction of new treatment options have dramatically alt ered the approach to gallstone management. Most patients with cholelit hiasis are asymptomatic, and for them, expectant management is now rec ommended by many authorities. This approach may also be acceptable for some patients who have only occasional episodes of biliary colic. Lap aroscopic cholecystecgtomy is preferred for patients who have had repe ated episodes of biliary colic or acute cholecystitis and who are suit able operative candidates. Nonsurgical options include oral dissolutio n therapy with bile acids, extracorporeal shock wave lithotripsy, and contact dissolution with methyl tertbutyl ether. Each has significant limitations but may be considered for selected patients with symptomat ic gallstones who are not candidates for general anesthesia or who ref use surgery Future improvements in non-surgical therapies may ultimate ly expand their use.