From the FDA Drug Label
Ursodiol is indicated for patients with radiolucent, noncalcified gallbladder stones < 20 mm in greatest diameter in whom elective cholecystectomy would be undertaken except for the presence of increased surgical risk due to systemic disease, advanced age, idiosyncratic reaction to general anesthesia, or for those patients who refuse surgery.
The patient has a 1.1 cm mobile gallbladder stone, which is less than 20 mm in diameter and may be considered for non-surgical treatment with ursodeoxycholic acid (Ursodiol) if the stone is radiolucent and noncalcified. However, the decision for surgical evaluation should be based on the patient's overall clinical condition, symptoms, and presence of any high-risk factors.
- The patient's stone size is within the range for potential dissolution with Ursodiol therapy.
- Surgical evaluation may still be necessary if the patient has symptoms or other high-risk factors. 1
From the Research
Yes, a patient with a 1.1 cm mobile gallbladder stone should be referred for surgical evaluation, typically for consideration of laparoscopic cholecystectomy (gallbladder removal). This recommendation applies even if the patient is currently asymptomatic, as gallstones of this size carry a significant risk of developing complications such as acute cholecystitis, biliary colic, pancreatitis, or bile duct obstruction 2. While not all patients with gallstones require immediate surgery, stones larger than 8 mm, like this 1.1 cm stone, are more likely to cause symptoms or complications over time. The mobility of the stone increases the risk of it migrating and potentially obstructing the cystic or common bile duct.
Some key points to consider in the management of gallbladder stones include:
- The risk of complications associated with gallstones, including acute cholecystitis, biliary colic, pancreatitis, and bile duct obstruction 3, 2
- The importance of preoperative evaluation, including liver function tests, complete blood count, and possibly additional imaging if complications are suspected
- The potential benefits and risks of surgical treatment, including laparoscopic cholecystectomy, and the importance of discussing these with the patient
- The potential for alternative management options, such as observation with lifestyle modifications or medications like ursodeoxycholic acid, for patients who are poor surgical candidates due to comorbidities 4
It's worth noting that the provided evidence includes a range of studies on gallbladder disorders, including a comprehensive review of literature on the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease 2. However, the most relevant study for this specific question is the one that discusses the management of gallbladder stones and the importance of surgical evaluation for patients with stones larger than 8 mm 2.