What tests are used to diagnose Gallstones?

The most important parts of any diagnostic process are the patient’s description of symptoms and the doctor’s physical examination. When gallstones are suspected, routine liver blood tests are helpful since bile flow may be blocked and bile may back up into the liver.

Two excellent radiographic (X–ray) tests are used to determine the presence of gallstones. The first is abdominal ultrasound, in which a microphone is used to bounce sound waves against hard objects like stones. The second is an oral cholecystogram (OCG), in which an X–ray of a dye–filled gallbladder is taken after the patient swallows dye–containing pills. Both tests are about 95 percent effective in diagnosing gallstones. Ultrasound is more commonly performed because it is completely non–invasive (no injections), does not involve exposure to X–rays, and there are no pills to swallow.

Unfortunately it is more difficult to diagnose gallstones once they have entered the common bile duct. Ultrasound is much less sensitive in the bile duct, and OCG cannot be used at all. The best tests involve putting X–ray dye directly into the bile ducts. A flexible swallowed tube can be used (endoscopic retrograde cholangiopancreatography or ERCP), or a needle can be passed through the liver and into the bile ducts (percutaneous transhepatic cholangiography or PTC). These tests both carry small risks, require X–ray exposure, and may be uncomfortable or require use of sedation. Their use is therefore reserved for certain patients.

What treatments are available for Gallstones?

Many new approaches to gallstone treatment have been tried over the past several years, but surgical removal of the gallbladder (Cholecystectomy) remains the most widely used therapy. This is partly because the newer non–surgical treatments are useful in only some gallstone patients, but surgery can be used in virtually all patients. Patients generally do well after surgery and have no difficulty with digesting food, even though the gallbladder’s function is to aid digestion. Surgical options include the standard procedure, called open Cholecystectomy, and a newer, less invasive procedure called laparoscopic Cholecystectomy ("belly–button surgery").

In open Cholecystectomy, the surgeon removes the gallbladder through a five– to eight–inch incision. This procedure has been performed for more than 100 years and is quite safe, although four or five days of hospitalization and several weeks of recuperation at home are usually needed.

Laparoscopic Cholecystectomy is a recent technique which was introduced in the United States in 1988. The surgeon makes several incisions in the abdomen through which a tiny video camera and surgical instruments are passed. The video picture is viewed in the operating room on a TV screen, and the gallbladder can be removed by manipulating the surgical instruments. Because the abdominal muscles are not cut there is less postoperative pain, quicker healing, and better cosmetic results. The patient can usually go home from the hospital within a day and resume normal activities within a few days.

Each approach has its advantages, and a doctor can recommend the best method for each patient depending upon the clinical situation. For instance, it may be difficult or dangerous to remove a severely inflamed gallbladder laparo–scopically. It may also be more difficult to remove a stone from the bile duct laparo–scopically, if one is found at surgery to have passed out of the gallbladder and into the duct. However, stones in the bile duct can frequently be left in place and removed at a later date using a non–operative method such as ERCP.

Gallbladder surgery may be complicated by injury to the bile duct, leading either to leakage of bile or scarring and blockage of the duct. Mild cases can frequently be treated without surgery, but severe injury generally requires bile duct surgery. Bile duct injury is the most common complication of laparoscopic Cholecystectomy, and may be more common with the laparoscopic than the standard approach.