Gallstone disease: Optimal timing of treatment

Gallstones are common and affect up to 20% of the European population. In general, symptomatic gallstones represent an indication for treatment. The European Association for the Study of the Liver has published the latest Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. [1] Lammert F. Acalovschi M. Ercolani G. van Erpecum K. Gurusamy K.S. van Laarhoven C.J. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016; 65: 146-181 Abstract Full Text Full Text PDF PubMed Scopus (248) Google Scholar In this Snapshot, we visualize the current treatment algorithms and discuss the optimal timing of the recommended interventions. These recommendations are based on new randomized controlled clinical trials in patients with biliary symptoms or complications. Although the genetics and pathophysiology of gallstones have been clarified, medical preventive measures would be too complex and expensive and the treatment algorithms remain predominantly invasive and based on surgery. [2] Lammert F. Gurusamy K. Ko C.W. Miquel J.F. Méndez-Sánchez N. Portincasa P. et al. Gallstones. Nat Rev Dis Primers. 2016; 2: 16024 Crossref PubMed Scopus (242) Google Scholar Therefore future studies should focus on preventive strategies to overcome the onset of gallstones, particularly in at-risk patients, but also in the general population.