Clinical Question

Is it safe to watch patients with symptomatic gallstone disease without complications?

Bottom Line

Uncomplicated gallstones can be managed over time with analgesia and monitoring, although approximately 25% of patients will undergo cholecystectomy over the following 18 months. Yet, there appears to be no need to rush to surgery without evidence of common bile duct blockage or acute pancreatitis. (Level of Evidence = 1b−)

Synopsis

The British researchers enrolled 434 adults with uncomplicated, symptomatic gallstone disease referred to secondary care. Using concealed allocation, the patients received conservative management or laparoscopic cholecystectomy. Patients were excluded if they had evidence or history of common bile duct gallstones, acute pancreatitis, obstructive jaundice, or infection. A total of 67% of the participants were assigned to surgery over the next 18 months, and 25% of the participants who were assigned to conservative management had surgery. In the intention-to-treat analysis, patients were evaluated in their original group (despite crossover to the other group), and the analysis showed that pain scores over 18 months were similar in both groups. Quality of life, measured by quality-adjusted life years, was similar in both groups. In the United Kingdom, initial assignment to the conservative approach saved £1,033 ($1,334) over time after accounting for the use of health sources over 18 months.