Some people with gallstones never exhibit symptoms, while others experience severe pain. If you are experiencing pain in the upper abdomen or right side of the body, you may have gallstones, and will want to seek treatment to avoid further complications. At least in the United States, about 25 percent of newly diagnosed patients with gallstones will need treatment. The gallbladder’s main function is to store bile, a substance secreted by the liver that helps with digestion. Sometimes bile contents crystallize and form gallstones. Gallstones, which can be as small as a grain of salt or as large as a golf ball, can cause some serious problems. They can block ducts inside the organ, causing the gallbladder to become inflamed. Even worse, when a gallstone passes out of the gallbladder duct and into the main bile duct, it can lead to a bile duct infection that can ultimately cause inflammation of the pancreas.
Why Treatment for Gallstones Is Necessary
Besides alleviating symptoms, treatment for gallstones is necessary to avoid a progression that can result in severe conditions, such as acute cholecystitis, the condition in which the gallstone blocks the gallbladder ducts, causing the gallbladder to become inflamed and infected. Patients with acute cholecystitis are usually hospitalized and receive antibiotics, pain medication, and often surgery. If you do not have symptoms, the most common treatment is to “wait and see,” because the risks outweigh the benefits for both medical and surgical treatments. If you have gallbladder symptoms, surgical treatments are preferred unless you are at high risk, and then drug treatments may be utilized. “If someone is symptomatic, we do recommend patients get the gallbladder taken out,” says Nikhil Kumta, MD, an attending gastroenterologist at Mount Sinai Hospital in New York City. “[Gallbladder surgery] is minimally invasive, so the risk of complications is low. But if people are unable to go through surgery, if someone is really old or really sick, there are different treatment options.” Here are seven alternatives to surgery:
1. Thinning Bile With Acid Pills Can Dissolve Gallstones
In some cases, gallstones can be treated with medicine. Certain chemicals, such as ursodiol or chenodiol, which have been shown to dissolve some gallstones, are available in oral bile acid pills. These medicines work by thinning the bile, which allows gallstones to dissolve. While these pills can be effective and are generally well tolerated by patients, medical treatment of gallstones is limited to people whose stones are small and made of cholesterol. But according to Mount Sinai, these drugs can take two years or longer to work, and gallstones may return after treatment ends. “Decreasing the cholesterol content of the bile can dissolve (certain gallstones), but it’s not effective enough that we don’t refer patients to surgery,” Dr. Kumta says.
2. Small Gallstones Can Be Broken Apart With Shock Waves
Another nonsurgical treatment for which gallstones must meet certain criteria is extracorporeal shock-wave lithotripsy (ECSWL). Although it is most commonly used to treat kidney stones, it can also be used on gallstones. The goal of the treatment is to break up, or fragment, gallstones by sending shock waves through the soft tissue of the body. This method is only effective on solitary gallstones that are less than 2 centimeters in diameter, so fewer than 15 percent of patients are eligible for ECSWL. A case report published in 2017 in the International Journal of Surgery Case Reports found a low success rate for ECSWL patients with multiple gallstones. Even when stones are fragmented, a diseased gallbladder may not expel the fragment. According to research published in the October-December 2014 issue of the Journal of Indian Association of Pediatric Surgeons, for this form of treatment, children may be the best candidates.
3. Gallstones Can Be Dissolved With an MTBE Injection
This nonsurgical treatment option involves injecting a solvent known as methyl tertiary-butyl ether (MTBE) into the gallbladder to dissolve the gallstones. According to research published in June 2015 in the journal Case Reports in Surgery, MTBE rapidly dissolves gallstones — but there can be some serious side effects, such as severe burning pain. MTBE creates fumes, and if it’s not administered properly in a ventilated area, it could cause severe burning for the patient and operators, and even cause electrical fires. Inquire about your doctor’s level of experience with performing this procedure before getting this form of treatment.
4. Endoscopic Drainage Follows the Gallbladder’s Natural Path
Endoscopic drainage mimics the healthy route of bile from the gallbladder to the small intestine. An endoscopic transpapillary treatment involves accessing the cystic duct with a camera through the mouth and down the throat. Then a wire is placed through the duct into the gallbladder. It is coiled to imitate the trajectory of the bile out of the small intestine, which is the same process as that of a healthy gallbladder. Kumta says that this form of treatment allows the gallbladder to resume normal bile disposal.
5. Percutaneous Cholecystostomy Is Best for Seriously Ill Patients
This is a nonsurgical treatment option, but it’s most effective when followed by gallbladder removal. Percutaneous cholecystostomy (PC) is typically saved for seriously ill patients who cannot tolerate surgery right away. The procedure involves using a needle to withdraw fluid from the gallbladder and then inserting a catheter through the skin to drain the fluid. The catheter is left in place for a number of weeks, after which gallbladder removal surgery is performed to prevent recurrence.
6. Transmural Drainage Decompresses a Swollen Gallbladder
“Transmural drainage creates a new tract directly through the stomach into the gallbladder,” Kumta says. An expandable metal stent is then placed to allow the gallbladder to drain into the small intestine. “This allows the gallbladder to decompress.” With this approach, a study published in March 2016 in the journal Therapeutic Advances in Gastroenterology found high success rates, with one only 1 out of 16 patients experiencing complications during the stent placement process.
7. Acute Cholecystostomy, an Ultrasound-Guided Drainage Procedure
For patients who have acute cholecystitis or gallbladder inflammation and are unable to have surgery, an endoscopic stent can be placed between the gallbladder and alimentary tract to drain infection in a procedure called acute cholecystoenterostomy (ACE). A meta-analysis published in April 2018 in the journal Surgical Endoscopy found that ACE was just as effective, if not more effective, than percutaneous cholecystostomy in managing the pain and re-intervention rates of acute cholecystitis. “Sometimes the surgeons will opt to do this before surgery when the gallbladder is inflamed. We give the patient antibiotics and drain the gallbladder so that it isn’t hot, sticky, and inflamed during surgery,” Kumta says.
When Considering Treatment Options, Talk to Your Doctor
As a gastroenterologist, Kumta always refers people to a surgeon if they are experiencing pain in their right abdomen, so that they can learn the pros and cons of removing the gallbladder. Still, Kumta says that obesity is correlated with gallstone formation, and that patients can make dietary changes, lose weight if they are obese, and opt for a low-fat diet. If you pick the change your diet, “wait and see” approach, be mindful of the factors that predispose someone to gallstones: You can’t control your age, your gender (women are more prone to gallstones), or your genes. If you have gallstones, knowing what’s available to remove or otherwise treat them can help you in making your treatment decisions. Discuss these treatment options with your doctor and find the one that’s right for you. Additional reporting by Calley Nelson
