Effective treatment of gallstones: A Synthesis of Findings from 19 Studies

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Original Abstract of the Article

Key Research Findings

Effective treatment for gallstones aims to reduce symptoms, prevent recurrence, and avoid complications such as cholecystitis and pancreatitis. A variety of treatments exist and the best option depends on the individual patient's situation, including the type, size, location, and complications associated with the gallstones.

Here's a summary of key research findings related to gallstone treatment. 6 found that ursodeoxycholic acid (UDCA) can reduce the size of gallstones and alleviate symptoms by dissolving the cholesterol that makes up the stones. 2 showed that extracorporeal shock wave lithotripsy (ESWL) can break up gallstones, facilitating their passage. 7 compared ERCP (endoscopic retrograde cholangiopancreatography) with surgery for common bile duct stones and concluded that surgery is more effective at removing stones. 11 suggested that early laparoscopic cholecystectomy is more beneficial than delayed surgery in treating acute gallstone pancreatitis. 16 indicated that for individuals without symptoms, conservative management (observation) might be a feasible option.

Treatment Summary

6 reports that UDCA can shrink gallstones and alleviate symptoms by dissolving cholesterol. 2 highlights the effectiveness of ESWL in breaking up gallstones for easier passage. 7 concludes that surgery surpasses ERCP in eliminating common bile duct stones. 11 suggests that early laparoscopic cholecystectomy might be preferable to delayed surgery in managing acute gallstone pancreatitis. 16 indicates that observation could be an acceptable approach for individuals without gallstone-related symptoms.

Benefits and Risks

Benefit Summary

Gallstone treatments offer various benefits, including symptom relief, prevention of recurrence, and avoidance of complications like cholecystitis and pancreatitis. 6 demonstrated that UDCA can shrink gallstones and alleviate symptoms. 2 showed that ESWL is effective in breaking down gallstones for easier passage. 7 revealed that surgery is superior to ERCP in removing common bile duct stones. 11 suggests that early laparoscopic cholecystectomy could be more beneficial than delayed surgery in treating acute gallstone pancreatitis. 16 indicated that observation might be a safe option for individuals without gallstone symptoms.

Risk Summary

Gallstone treatments involve certain risks such as surgical complications and drug side effects. 6 reported diarrhea as a potential side effect of UDCA. 2 mentioned minor skin bruising as a possible consequence of ESWL. 7 acknowledged bleeding and infection as possible complications of surgery. 11 indicated a higher risk of complications associated with early laparoscopic cholecystectomy. 16 noted potential risks of observation, including gallstone growth and worsening symptoms.

Comparison of Studies

Commonalities

These studies explore various aspects of gallstone treatment. They share a common theme: gallstone treatment aims to reduce symptoms, prevent recurrence, and avoid complications like cholecystitis and pancreatitis. All studies acknowledge the existence of both benefits and risks associated with each treatment option.

Differences

The studies differ in their focus, patient populations, and treatments, leading to varied results. For instance, 7 compares ERCP with surgery for common bile duct stones, while 11 compares early laparoscopic cholecystectomy with delayed surgery for acute gallstone pancreatitis. Direct comparison is difficult because the patient characteristics and treatment approaches vary across studies.

Consistency and Contradictions in Results

Research on gallstone treatments exhibits both consistent and contradictory findings. For example, 7 found surgery more effective than ERCP in removing common bile duct stones, while 11 did not clearly demonstrate a superiority between early laparoscopic cholecystectomy and delayed surgery. These inconsistencies may stem from differences in patient populations, treatment methods, and study design.

Applying Research Findings to Daily Life

When applying gallstone treatment research to daily life, it is crucial to acknowledge several points. Firstly, these studies involved specific patient groups, making the findings not necessarily applicable to all individuals. Secondly, consider individual variability in response to treatment. Lastly, when considering new treatments, consult a physician to discuss risks, benefits, and determine the most appropriate approach for your specific needs.

Limitations of Current Research

Research on gallstone treatments faces certain limitations. Small sample sizes can affect the reliability of results. Inadequate study design can lead to bias. The absence of long-term follow-up studies limits the evaluation of long-term effects and risks.

Future Research Directions

Future research on gallstone treatments should address several areas. Large-scale studies encompassing a broader patient base are needed. Improved study design is essential to minimize bias. Long-term follow-up studies are crucial to assess long-term effects and risks comprehensively.

Conclusion

The optimal treatment for gallstones depends on various factors, including symptoms, type, size, location, and complications associated with the gallstones. Consult with a physician, considering research findings, risks, and benefits to determine the most suitable treatment for your unique situation.

If you experience symptoms related to gallstones, seek medical attention promptly.

Treatment List

Ursodeoxycholic acid (UDCA)

Extracorporeal shock wave lithotripsy (ESWL)

Endoscopic retrograde cholangiopancreatography (ERCP)

Surgery

Laparoscopic cholecystectomy

Observation

Literature analysis of 19 papers
Positive Content
17
Neutral Content
0
Negative Content
2
Article Type
7
8
11
12
19
1.

[Changes in the pattern of serum biliary acids and lipoprotein picture during therapy with biliary acids in cholesterol lithiasis].

Author: Di MarioF, AngoneseC, Del FaveroG, AggioL, MeggiatoT, ScalonP, BassoD, PlebaniM, BurlinaA, NaccaratoR

Possible cholesterol reduction

This study examined the effects of two bile acid treatments (chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA)) on cholesterol, triglycerides, and bile acid levels in 112 patients with gallstones. CDCA led to a slight decrease in cholesterol, triglycerides, and phospholipids, while UDCA had no effect on these levels. Both treatments had no impact on HDL cholesterol or lipoproteins. While CDCA increased bile acid levels, this did not correlate with treatment success. The study suggests that UDCA may be a preferable treatment for gallstones as it does not affect lipid levels.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : Italian

2.

Biliary lithotripsy.

Author: VanderpoolD, JonesR C, O'LearyJ P, HamiltonJ K

Gallstone fragmentation
Pain reduction
Stone clearance
Biliary colic
Skin bruising

This study investigated the effectiveness of lithotripsy, a non-surgical procedure that uses sound waves to break up gallstones, in 55 patients. Patients were given ursodeoxycholic acid (bile acid) before and after the procedure. Lithotripsy successfully fragmented gallstones in 95% of patients, and in 97% of patients with a single gallstone under 20 mm in size. Half of the patients with small, single gallstones were completely clear of stones after treatment. While most patients experienced pain before treatment, about a third experienced biliary colic after treatment, and 20% had minor bruising. The study suggests that lithotripsy combined with bile acid therapy is a promising treatment for gallstones.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Treatment of radiolucent gallstones with CDCA or UDCA. A multicenter trial.

Author: PolliE E, BianchiP A, ConteD, SironiL

Gallstone dissolution
Symptom improvement
Cholecystitis
Diarrhea
Increased SGOT

This study of 116 patients with radiolucent gallstones found that CDCA and UDCA were equally effective in dissolving gallstones. UDCA at a higher dose (10-12 mg/kg/day) may be more effective for dissolving smaller stones.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Gallstone recurrence after successful dissolution therapy.

Author: TudykaJ, WechslerJ G, KratzerW, MaierC, MasonR, KuhnK, AdlerG

Gallstone prevention
Biliary pain

After complete removal of cholesterol gallstones, a treatment with ursodeoxycholic acid (UDCA), aspirin, or diet therapy reduces the probability of recurrent stones, as compared to no treatment. In the untreated group, multiple stones were more likely to recur than solitary stones. Recurrent stones tended to appear early after dissolution therapy, often within one year, and caused biliary pain.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Long term response to gallstone treatment--problems and surprises.

Author: AhmedR, FreemanJ V, RossB, KohlerB, NichollJ P, JohnsonA G

Improved quality of life
Reduced pain episodes
Worse outcome with crossover

Cholecystectomy is more effective than lithotripsy for the treatment of symptomatic gallstones. Lithotripsy resulted in good symptomatic results in 55% of patients, but patients who had a cholecystectomy after lithotripsy had the worst symptomatic results.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Ursodeoxycholic acid decreases viscosity and sedimentable fractions of gallbladder bile in patients with cholesterol gallstones.

Author: FischerSven, MüllerIris, ZündtBenedikta Z, JüngstChristoph, MeyerGünther, JüngstDieter

Gallstone treatment

The study investigates the effects of ursodeoxycholic acid (UDCA) treatment on gallbladder bile composition, viscosity, and sedimentable fractions in patients with symptomatic cholesterol gallstones.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Surgical versus endoscopic treatment of bile duct stones.

Author: MartinD J, VernonD R, ToouliJ

Laparoscopic CBD clearance
Shorter hospital stays
Increased procedures
Mortality risk

For patients with common bile duct stones, open bile duct surgery was superior to ERCP for stone clearance in the era of open cholecystectomy. In the laparoscopic era, laparoscopic CBD stone clearance is comparable to ERCP, but ERCP requires more procedures per patient.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy.

Author: GurusamyK S, SamrajK, MulleratP, DavidsonB R

Reduced pain
Delayed discharge
Increased infections

Drain use after elective laparoscopic cholecystectomy reduces early post-operative pain, but increases wound infection rates and delays hospital discharge.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy.

Author: GurusamyK S, SamrajK, MulleratP, DavidsonB R

Reduced abdominal collections
Delayed discharge
Wound infection

This review found that drain use after elective laparoscopic cholecystectomy increases wound infection rates and delays hospital discharge. There is no evidence to support the routine use of drains after laparoscopic cholecystectomy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness.

Author: LambertsMark P, LugtenbergMarjolein, RoversMaroeska M, RoukemaAnne J, DrenthJoost P H, WestertGert P, van LaarhovenCornelis J H M

Improved gallstones treatment

This study aims to assess the effectiveness of elective cholecystectomy for patients with cholecystolithiasis in terms of both persistent and new symptoms.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis.

Author: GurusamyKurinchi Selvan, NagendranMyura, DavidsonBrian R

Gallstone treatment
Controversial timing

This study discusses the timing of laparoscopic cholecystectomy after an attack of acute biliary pancreatitis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Surgical versus endoscopic treatment of bile duct stones.

Author: DasariBobby V M, TanChuan Jin, GurusamyKurinchi Selvan, MartinDavid J, KirkGareth, McKieLloyd, DiamondTom, TaylorMark A

Bile duct stone removal

This study will investigate the benefits and harms of different approaches to treating common bile duct stones, including open surgery, laparoscopic surgery, and endoscopic retrograde cholangiopancreatography (ERCP).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy.

Author: GurusamyKurinchi Selvan, KotiRahul, DavidsonBrian R

Improved quality of life
No significant difference
Shorter hospital stay
Longer operating time

This Cochrane review assessed the benefits and harms of routine abdominal drainage after uncomplicated laparoscopic cholecystectomy. There is currently no evidence to support the routine use of drain after laparoscopic cholecystectomy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Surgical versus endoscopic treatment of bile duct stones.

Author: DasariBobby V M, TanChuan Jin, GurusamyKurinchi Selvan, MartinDavid J, KirkGareth, McKieLloyd, DiamondTom, TaylorMark A

Gallstone removal

Between 10% and 18% of individuals undergoing cholecystectomy for gallstones have common bile duct stones. Treatment options include open cholecystectomy plus open common bile duct exploration, laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC + LCBDE), or pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages. The benefits and harms of these approaches are not well understood.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Systematic review of the clinical and cost effectiveness of cholecystectomy versus observation/conservative management for uncomplicated symptomatic gallstones or cholecystitis.

Author: BrazzelliMiriam, CruickshankMoira, KilonzoMary, AhmedIrfan, StewartFiona, McNameePaul, EldersAndy, FraserCynthia, AvenellAlison, RamsayCraig

Gallstone treatment

Gallstones are a common digestive problem. While surgery is the usual treatment, observation (watching and waiting) can also be safe and effective. This review examines the evidence for surgery versus observation for gallstones, considering the cost-effectiveness of each approach.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation.

Author: BrazzelliMiriam, CruickshankMoira, KilonzoMary, AhmedIrfan, StewartFiona, McNameePaul, EldersAndrew, FraserCynthia, AvenellAlison, RamsayCraig

Gallstone treatment

Gallstones affect about 10-15% of adults, with women more likely to be affected than men. While surgery is the standard treatment for gallstone-related pain, some people don't experience another episode after their initial attack. While most research focuses on surgery, less attention has been paid to the effects of simply observing patients without surgery.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

Endoscopy Lithotomy for Intrahepatic Gallstones: A Meta-Analysis.

Author: MaShumin, HuSanyuan, GaoFeng, LiangRui

Complete stone removal
Stone recurrence
Stricture impact

Intrahepatic biliary stricture is a major cause of treatment failure for intrahepatic stones and stone recurrence. To prevent recurrent cholangitis or cholangiocarcinoma, complete removal of intrahepatic gallstones is very important.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

A randomized controlled trial to compare a restrictive strategy to usual care for the effectiveness of cholecystectomy in patients with symptomatic gallstones (SECURE trial protocol).

Author: de ReuverP R, van DijkA H, WennmackerS Z, LambertsM P, BoermaD, den OudstenB L, DijkgraafM G W, DonkervoortS C, RoukemaJ A, WestertG P, DrenthJ P H, van LaarhovenC J H, BoermeesterM A

Treatment for gallstones

This trial aims to compare the effectiveness of usual care (operative) with a restrictive strategy using a standardized work-up for cholecystectomy in patients with gallstones and abdominal complaints.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

19.

Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.

Author: MoodyN, AdiamahA, YanniF, GomezD

Cholecystectomy
Gallstone pancreatitis treatment

Gallstones are a common cause of acute pancreatitis, which is inflammation of the pancreas. While treatment for acute pancreatitis is typically supportive, surgery to remove the gallbladder is the standard treatment for gallstone pancreatitis. Guidelines recommend this surgery during the initial hospital stay or within two weeks of discharge, but many doctors don't follow these guidelines.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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