Cholezystolithiasis – ein Wandel im interdisziplinären Vorgehen?

Abstract

Cholecystolithiasis has an enormous clinical and socioeconomic impact due to its high prevalence and the risk to develop severe complications. 80% of persons with gallstones are asymptomatic at the time of diagnosis. After a first episode of biliary symptoms, about 70% of patients will experience recurrent biliary symptoms within 2 years, and 1-2% per year will develop biliary complications. The diagnosis of gallstone disease is made on the basis of the patient's history, a physical examination, an abdominal ultrasound, and laboratory tests to exclude complications such as cholecystitis, cholangitis, choledocholithiasis, and pancreatitis. Asymptomatic cholecystolithiasis is usually not treated. Exceptions are a porcelain gallbladder, simultaneous gallbladder polyps ‡ 10 mm, and gallstones > 3 cm due to the enhanced risk to develop gallbladder carcinoma. In addition, prophylactic cholecystectomy may be considered in asymptomatic patients undergoing heart transplantation or surgery for morbid obesity. Laparoscopic cholecystectomy represents the first-line treatment of symptomatic cholecystolithiasis. Nonsurgical treatment with ursodeoxycholic acid should only be considered in patients with small (£ 5(-10) mm), mildly symptomatic gallbladder stones in a functioning gallbladder when surgery is refused by the patient, surgical risk is high, or surgery is impossible. Extracorporeal shock wave lithotripsy of gallbladder stones is not recommended any more considering recurrence rates of 50-80% after 10 years.