What is the prognosis for a patient with gallstones who refuses surgical intervention?

From the Guidelines

Patients with gallstones who refuse surgery are at a higher risk of developing complications, such as acute cholecystitis, pancreatitis, or bile duct obstruction, and should be closely monitored by a healthcare provider. The prognosis for these patients depends on various factors, including the presence of symptoms, the size and number of gallstones, and the patient's overall health. According to a study published in 2019 1, the mortality rate for elderly patients with acute calculous cholecystitis (ACC) who received conservative treatment was higher compared to those who underwent surgery.

For asymptomatic gallstones, watchful waiting is often appropriate, as many patients will not experience any problems 1. However, for patients with symptomatic gallstones, dietary modifications, such as avoiding fatty and fried foods, maintaining regular meals, and gradual weight loss if overweight, can help manage symptoms. Pain management during acute episodes typically involves NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg initially, then 250mg every 6-8 hours). Ursodeoxycholic acid (8-10mg/kg/day) may help dissolve cholesterol stones in select patients, though this takes months and stones often recur after stopping treatment.

Some key points to consider in the management of patients with gallstones who refuse surgery include:

• Regular follow-up with a healthcare provider to monitor for complications
• Immediate medical attention for severe pain, fever, jaundice, or persistent vomiting
• Consideration of alternative treatments, such as percutaneous drainage of the gallbladder or retrograde endoscopic procedure, for elderly or high-risk patients
• Evaluation of the patient's frailty score to stratify surgical risk, as frail patients are at increased risk of morbidity or mortality from minor external stresses 1

Overall, while surgery is often the recommended treatment for gallstones, patients who refuse surgery can still be managed conservatively with close monitoring and appropriate treatment of symptoms. However, the risk of complications and mortality is higher in patients who do not undergo surgery, and patients should be aware of these risks.

From the FDA Drug Label

For patients with silent or minimally symptomatic stones, the rate of development of moderate-to-severe symptoms or gallstone complications is estimated to be between 2% and 6% per year, leading to a cumulative rate of 7% to 27% in 5 years Presumably the rate is higher for patients already having symptoms.

The prognosis for a patient with gallstones who refuses surgical intervention is that they have a cumulative risk of 7% to 27% of developing moderate-to-severe symptoms or gallstone complications within 5 years. This risk is estimated to be higher for patients who are already experiencing symptoms. 2

From the Research

Prognosis for Patients with Gallstones Refusing Surgery

The prognosis for a patient with gallstones who refuses surgical intervention is a complex issue, and the available evidence does not directly address this specific scenario. However, we can consider the following points:

• Alternative Treatments: For patients with gallstones who cannot undergo surgery, alternative treatments such as oral dissolution therapy with ursodeoxycholic acid (UDCA) or extracorporeal shock wave lithotripsy may be considered 3.
• Risk of Complications: Patients with gallstones who refuse surgery are at risk of developing complications such as cholecystitis, pancreatitis, or cholangitis. The prognosis for these patients depends on various factors, including the severity of the complication and the patient's overall health status.
• Medical Management: Medical management of gallstones may involve the use of antibiotics, pain management, and other supportive measures. The prognosis for patients with gallstones who receive medical management is generally poorer than for those who undergo surgical intervention.
• Quality of Life: Patients with gallstones who refuse surgery may experience a decreased quality of life due to ongoing symptoms such as pain, nausea, and vomiting.

Factors Affecting Prognosis

Several factors can affect the prognosis for patients with gallstones who refuse surgery, including:

• Age and Comorbidities: Older patients or those with significant comorbidities may be at higher risk of complications and have a poorer prognosis.
• Severity of Symptoms: Patients with severe symptoms such as jaundice, fever, or abdominal pain may have a poorer prognosis than those with milder symptoms.
• Presence of Other Conditions: Patients with other conditions such as diabetes, hypertension, or liver disease may be at higher risk of complications and have a poorer prognosis.

Considerations for Patients Refusing Surgery

For patients who refuse surgery, the following considerations are important:

• Informed Decision-Making: Patients should be fully informed about the risks and benefits of surgical intervention versus alternative treatments.
• Alternative Treatments: Alternative treatments such as oral dissolution therapy or extracorporeal shock wave lithotripsy may be considered for patients who refuse surgery.
• Ongoing Monitoring: Patients who refuse surgery should be closely monitored for signs of complications and receive prompt medical attention if symptoms worsen.
• Palliative Care: Palliative care may be considered for patients with advanced disease or significant comorbidities to improve quality of life.

Note: The provided evidence does not directly address the prognosis for patients with gallstones who refuse surgery. The information provided is based on general knowledge and may not be specific to the patient's individual situation.