Expectant Management of Patients with Gallbladder Stones Diagnosed at Planned Investigation A Prospective 5- to 7-Year Follow-Up Study of 153 Patients

Abstract

Background: Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation, and results are conflicting. Methods: A prospective 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography was carried out. Results: An acute gallstone complication occurred during the follow-up period in 23 patients (15%)—that is, acute cholecystitis (n = 18), acute pancreatitis (n = 2), and jaundice (n = 3). The annual risk of developing an acute biliary complication was 3.1%. A history of a gallstone complication predicted further gallstone complications during follow-up. The overall cholecystectomy rate was 20% during the 1st year but fell to about 3% during the 5th year of follow-up. Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery. Conclusions: Expectant management of patients with electively diagnosed cholelithiasis may be justified, especially in those with only occasional biliary symptoms and no history of gallstone complications.

Key Words:

• Cholelithiasis
• expectant management
• natural course
• predictive factors
• prognosis