Excerpt

Gallstone disease is the term used in this guideline to refer to the presence of stones in the gallbladder or common bile duct and the symptoms and complications they cause. The following aspects of gallstone disease are included in this guideline: Asymptomatic gallbladder stones; symptomatic gallbladder stones, including biliary colic, acute cholecystitis, Mirrizi syndrome, and Xanthogranulomatous cholecystitis; common bile duct stones, including biliary colic, cholangitis, obstructive jaundice and gallstone pancreatitis; other complications of gallstones (such as gastric outlet obstruction, or gallstone ileus) and other conditions related to the gallbladder (such as gallbladder cancer, or biliary dyskinesia) are not included in this guideline.

Most people with gallstone disease have asymptomatic gallbladder stones, meaning the stones are confined to the gallbladder and they do not have any symptoms. The disease is identified coincidentally as a result of investigations for other conditions. People with asymptomatic gallbladder stones may never go on to develop symptoms or complications, but there is variation within the NHS in how people are managed once asymptomatic gallbladder stones have been diagnosed. Some patients are offered treatments to prevent symptoms and complications developing, and others are offered a watch and wait approach so that active treatment only begins once the stones begin to cause symptoms.

The symptoms of gallstone disease range from mild, non-specific symptoms that can be difficult to diagnose, to severe pain and/or complications which are often easily recognised as gallstone disease by health professionals. People with mild, non-specific symptoms of gallstone disease may attribute their symptoms to other conditions, or may be misdiagnosed and undergo unnecessary investigations and treatment. This has a detrimental effect on quality of life and has an impact on the use of NHS resources. Thus, there is a need to identify whether there are any specific signs, symptoms or risk factors for gallstone disease and to identify the best method for diagnosing the condition so that patients can be managed appropriately.

There is uncertainty about the best way of treating gallstone disease. There are a range of endoscopic, surgical and medical treatments available, but it is unclear which treatments are the most appropriate for which patients. There is also uncertainty about the timing of cholecystectomy, and whether it should take place during the acute presentation of the disease, or if it should be delayed until after the acute symptoms have subsided.

This guideline addresses these uncertainties and provides recommendations on how to identify, diagnose and manage gallstone disease.

Contents

• 1. Overview
  • Patient-centred care
• 2. Summary Section
  • Guideline development group (GDG) members
  • Internal clinical guidelines team
  • Centre for Clinical Practice commissioning team
  • 2.1. Key priorities for implementation
  • 2.2. Algorithm
  • 2.3. List of all recommendations
  • Research recommendations
  • Strength of recommendations
• 3. Methods
  • 3.1. Additional methods used in this guideline
• 4. Evidence Review and Recommendations
  • 4.1. Signs, symptoms and risk factors for gallstone disease
  • 4.2. Diagnosing gallstone disease
  • 4.3. Asymptomatic gallbladder stones
  • 4.4. Managing asymptomatic gallbladder stones
  • 4.5. Managing symptomatic gallbladder stones
  • 4.6. Managing common bile duct stones
  • 4.7. Timing of laparoscopic cholecystectomy
  • 4.8. Information for patients and their carers
• 5. Glossary & Abbreviations
• Appendix A. Guideline Development Group Declarations of Interest
• Appendix B. Scope
• Appendix C. Review protocols
• Appendix D. Search strategies
• Appendix E. Review flow charts
• Appendix F. Excluded studies
• Appendix G. Included studies
• Appendix H. Data analysis
• Appendix I. GRADE profiles
• Appendix J. Full Health Economics Report
• Appendix K. Methodology checklist

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.