Treatment-cholelithiasis

(Am Fam Physician 2014;89:795; J Hepatol 2016;65:146)

• Cholecystectomy (CCY), usually laparoscopic, if symptomatic (earlier is better)

• CCY in asx Pts if: GB calcification (↑ risk of cancer), GB polyps >10 mm, stones >3 cm; Pts undergoing bariatric surgery, cardiac Tx candidates, hemolytic anemia (sickle cell)

• Options if ↑ risk for surgery: percutaneous drainage, endoscopic transpapillary drainage

• UDCA can be trialed for cholesterol stones w/ biliary pain or if poor surgical candidate, but takes ~3 mo to work; ↓ risk of gallstone formation that occurs w/ rapid wt ↓

• Pain: NSAIDs drugs of choice, efficacy ≈ opiates & avoids ↑ sphincter of Oddi pressure