Nice | Gallstone disease

This is a new guideline from NICE on gallstone disease. It doesn't say anything very surprising and doesn't change our current management, but does try to unify practice, which can currently be quite variable.

Remember that 15% of adults have gallstones, but only some of these will go on to have symptoms from them.

Investigations

  • LFT
  • USS

If there are abnormal LFT or a dilated biliary tree, but no gallstones are found, refer them as they will likely need MRCP (MR cholangiopancreatography). Endoscopic USS may be needed if MRCP doesn't give a diagnosis.

Advice to patients

Advise to avoid food or drink triggers until they have had surgery

Management

  • Asymptomatic gallstones (ie no symptoms in the last 12m) - no treatment needed, if there is a normal gallbladder and biliary tree.
  • Acute cholecystitis - cholecystectomy within 1w
  • Gallbladder empyema - percutaneous cholecystostomy then consider cholecystectomy once well enough.
  • Bile Duct stones - whether symptomatic or asymptomatic, will need bile duct clearance at the time of or before cholecystectomy

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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