Treatment for Cholesterolosis
Cholesterolosis of the gallbladder is a benign condition that typically requires no specific treatment unless symptomatic or associated with gallstones.
Understanding Cholesterolosis
Cholesterolosis is a benign condition characterized by cholesterol ester deposits in the gallbladder wall, creating a "strawberry gallbladder" appearance. This is fundamentally different from systemic cholesterol disorders and does not respond to lipid-lowering therapy. The evidence provided focuses on hyperlipidemia management, which is not applicable to gallbladder cholesterolosis.
Management Approach
Asymptomatic Cholesterolosis
- No treatment is required for incidentally discovered cholesterolosis without symptoms or complications
- Cholesterolosis itself does not increase cardiovascular risk or require lipid management
- Routine monitoring is unnecessary unless symptoms develop
Symptomatic Cholesterolosis
- Cholecystectomy is the definitive treatment if the patient experiences biliary colic, chronic right upper quadrant pain, or other gallbladder-related symptoms
- Laparoscopic cholecystectomy is the preferred surgical approach when intervention is needed
- Medical dissolution therapy with ursodeoxycholic acid is not effective for cholesterolosis
Associated Gallstones
- If cholesterolosis coexists with symptomatic cholelithiasis, cholecystectomy is indicated based on the gallstone symptoms
- The presence of cholesterolosis does not change the surgical indication or approach
Important Distinctions
Do not confuse cholesterolosis with hypercholesterolemia. The lipid-lowering guidelines and statin therapy recommendations 1 provided in the evidence are for managing elevated blood cholesterol levels to reduce cardiovascular risk—they have no role in treating gallbladder cholesterolosis. Statins, fibrates, ezetimibe, and other lipid-lowering agents 2, 3, 4, 5 do not prevent or treat cholesterolosis deposits in the gallbladder wall.
When to Refer
- Refer to general surgery if the patient develops biliary symptoms (postprandial right upper quadrant pain, nausea after fatty meals, biliary colic)
- Refer if imaging shows associated complications (acute cholecystitis, gallbladder polyps >10mm, gallbladder wall thickening with concerning features)