What are the non-surgical treatments for cholelithiasis (gallstones)?

From the Guidelines

Non-surgical treatment for gallstones should be considered for patients with small, non-calcified stones, and includes oral dissolution therapy with medications like ursodeoxycholic acid (Ursodiol) at doses of 8-10 mg/kg/day, as well as extracorporeal shock wave lithotripsy (ESWL) for solitary radiolucent stones smaller than 2 cm. According to the guidelines for the treatment of gallstones by the American College of Physicians 1, candidates for oral bile acids have small stones (diameter less than 0.5 cm) that float during oral cholecystography. The best candidates for lithotripsy have a solitary radiolucent stone smaller than 2 cm, with adjuvant oral bile acids.

• Key considerations for non-surgical treatment include:
  • Stone size and composition: small, non-calcified stones are more likely to respond to treatment
  • Patient preference: patients who refuse surgery or have high surgical risk may be candidates for non-surgical treatment
  • Gallbladder function: a functioning gallbladder is necessary for oral dissolution therapy to be effective
• Treatment options include:
  • Oral dissolution therapy with ursodeoxycholic acid (Ursodiol) at doses of 8-10 mg/kg/day divided into two doses for 6-24 months
  • Extracorporeal shock wave lithotripsy (ESWL) for solitary radiolucent stones smaller than 2 cm
  • Pain management during symptomatic episodes involves NSAIDs like ibuprofen (400-600 mg every 6 hours) or ketorolac
  • Dietary modifications such as reducing fat intake to less than 30% of total calories
• It is essential to note that non-surgical approaches have lower success rates and higher recurrence rates compared to surgical removal of the gallbladder, and patients should understand that these treatments don't prevent new stone formation, with approximately 50% of patients experiencing stone recurrence within 5 years after dissolution therapy, as suggested by the guidelines 1.

From the FDA Drug Label

SPECIAL NOTE Gallbladder stone dissolution with Ursodiol Capsules USP, 300 mg treatment requires months of therapy. The non-surgical treatment for gallstones is bile acid therapy, specifically with ursodeoxycholic acid (Ursodiol).

• This treatment requires months of therapy.
• It is not effective for all patients and recurrence of stones is possible. 2

From the Research

Non-Surgical Treatment for Gallstones

The non-surgical treatment for gallstones typically involves the use of medications to dissolve the stones. The following are some of the key points to consider:

• The standard treatment for symptomatic gallstone patients is laparoscopic cholecystectomy, but non-surgical medical therapy can be considered for patients with mild symptoms and small, uncalcified cholesterol gallstones in a functioning gallbladder with a patent cystic duct 3.
• Ursodeoxycholic acid is a commonly used medication for dissolving cholesterol gallstones, and it works by reducing biliary cholesterol secretion and increasing bile acid synthesis 4, 5.
• The effectiveness of ursodeoxycholic acid in dissolving gallstones depends on the size and number of stones, with smaller stones being more likely to dissolve 4, 5.
• Other medications, such as statins and ezetimibe, which inhibit cholesterol synthesis or intestinal cholesterol absorption, may also be effective in treating cholesterol gallstones 3, 6.
• The selection of patients for non-surgical therapy should be based on a careful analysis of the natural history of the disease, the overall costs of therapy, and the patient's individual clinical and personal situation 3, 7, 6.

Key Medications

Some of the key medications used in the non-surgical treatment of gallstones include:

• Ursodeoxycholic acid: a bile acid that reduces biliary cholesterol secretion and increases bile acid synthesis 4, 5.
• Statins: cholesterol-lowering agents that inhibit hepatic cholesterol synthesis 3, 6.
• Ezetimibe: a medication that inhibits intestinal cholesterol absorption 3, 6.
• Drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis: these medications may also be effective in treating cholesterol gallstones 3, 6.