Gallstones
Other Treatment
Other treatment options for gallstones are not widely available. Less is known about their effectiveness and long-term impact compared with surgery.
Other treatments for gallstones in the common bile duct
If gallstones are found in the common bile duct before or during surgery to remove the gallbladder, a doctor who specializes in the digestive system (gastroenterologist) may do an endoscopic retrograde cholangiopancreatogram (ERCP). An ERCP allows the doctor to see and remove the stones. In some people who cannot have surgery, an ERCP may be used with another procedure called endoscopic sphincterotomy that allows stones to pass more easily out of the duct.
Other Treatment Choices
Other treatments for gallstones in the gallbladder include:
- Lithotripsy. This procedure uses ultrasound waves to break up gallstones. It may be used alone or along with bile acids to break up stones. The procedure, which is now rarely performed, has been used for people who have long-term (chronic) inflammation of the gallbladder (cholecystitis) and who are not strong enough for surgery. But it is not appropriate in treating sudden (acute) cholecystitis.
- Contact dissolution therapy. This treatment uses a thin, flexible tube called a catheter to place a chemical in the gallbladder to dissolve gallstones. This therapy is rarely used because of the risk of complications, and unlike with surgery, gallstones may return.
- Percutaneous cholecystostomy. This procedure may provide temporary relief for an inflamed gallbladder until an endoscopic retrograde cholangiopancreatogram (ERCP) or surgery can be performed. During percutaneous cholecystostomy, a doctor places a tube through the abdomen and into the gallbladder to drain its contents. This sometimes is done for people who are not strong enough for surgery.
Other treatments for gallstones in the common bile duct include:
- Endoscopic retrograde cholangiopancreatogram (ERCP) with endoscopic sphincterotomy. In an ERCP, a doctor gently moves a flexible, lighted viewing instrument (endoscope) down your throat and through your stomach to examine the tubes that drain your liver and gallbladder. If you have a gallstone in the common bile duct, the gallstone can sometimes be removed through the endoscope. The doctor widens the opening between the common bile duct and the small intestine and takes the stone out using a small basket. Because surgery to remove the gallbladder prevents the return of gallstones, it is usually the best option. But you may have ERCP to remove stones in the common bile duct and then have surgery to remove your gallbladder.
What To Think About
Lithotripsy and contact dissolution therapy to treat gallstones are not used very often and are less effective than surgery to prevent symptoms caused by gallstones. Discuss with your health professional the risks, costs, and effectiveness of these seldom-used procedures.
When the gallbladder is not removed, such as in nonsurgical procedures, gallstones return within 5 years in 30% to 50% of people.8
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| Author: | Monica Rhodes | Last Updated: August 2, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology | |
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