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Gallstone disease is common-10-15% of adults in Western populations are thought to have the condition. 1 2 Concerns about inappropriate variation in the management of gallstones have led to the development of recommendations on the diagnosis and management of cholelithiasis, cholecystitis, and choledocholithiasis in an attempt to improve patient outcomes and promote effective use of resources. This article summarises the most recent recommendations on the management of gallstone disease from the National Institute for Health and Care Excellence (NICE). 3
Recommendations
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group's experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Diagnosis
Offer liver function tests and ultrasound to people with suspected gallstone disease and to people with abdominal or gastrointestinal symptoms that have not responded to previous management. [Based on moderate to very low quality observational studies ]
Consider magnetic resonance cholangiopancreatography if ultrasound has not detected common bile duct stones but the:
-Bile duct is dilated or
-Liver function test results are abnormal (or both).
[Based on moderate to very low quality observational studies ]
Consider endoscopic ultrasound if magnetic resonance cholangiopancreatography does not allow a diagnosis to be made. [Based on moderate to very low quality observational studies ]
Treating asymptomatic gallbladder stones
Reassure people with asymptomatic gallbladder stones found in a normal gallbladder and normal biliary tree that they do not need treatment unless they develop symptoms. [Based on the experience and opinion of the Guideline Development Group (GDG) ]
Treating symptomatic gallbladder stones and symptomatic or asymptomatic common bile duct stones
Offer laparoscopic cholecystectomy to people diagnosed with symptomatic gallbladder stones. [Based on moderate to low quality randomised controlled trials and an original health economic model ]
Offer bile duct clearance and laparoscopic cholecystectomy to people with symptomatic or asymptomatic common bile duct stones. [Based on moderate quality...