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Gallstones & Gallbladder Polyps

 

Background

Gallstones are common and occur when there is a problem relating to the chemical composition of bile. Most people with gallstone disease are asymptomatic and will remain asymptomatic. However, each year about 2-4% previously asymptomatic patients develop symptoms or complications.

The two most common complications are biliary colic, followed by acute cholecystitis. Other complications are rare, but some are life-threatening such as cholangitis (fever/rigors, jaundice, RUQ pain) and pancreatitis.

 

Referral criteria

Same day discussion with general surgeon on-call:

  • Systemically unwell with complications of gallbladder disease, i.e. acute cholecystitis, cholangitis or pancreatitis
  • Known gallstones and jaundice
  • Clinical suspicion of biliary obstruction i.e. significantly deranged LFTs
     

 

Routine/urgent referral to UGI surgery (dependent on clinical judgement):

1. Gallstones

  • Stones found on imaging and causing symptoms, within the last 12 months
  • Asymptomatic gallstones found in the CBD (for consideration of bile duct clearance and laparoscopic cholecystectomy)
  • Asymptomatic gallstones outside the CBD do not need to be referred


2. Gallbladder polyps

  • Symptomatic, or
  • Larger than 1cm, or
  • Gallstones present
  • Polyps less than 1cm in size, not referred for surgery, should have a repeat USS in 1 year due to risk of malignancy

 

Investigations prior to referral

  • LFTs
  • Abdominal USS (please attach results to referral)

 

 

Management of suspected retained stones after gallbladder surgery

  • LFTs and amylase
  • Urgent USS
  • Depending on clinical urgency, referral to jaundice clinic or if systemically unwell, discuss with UGI surgeon on-call via switch. MRCP and ERCP will then be arranged.

 

Nb. A dilated CBD post gallbladder surgery on its own is quite common after surgery and not necessarily suggestive of a retained stone.

 

 

References

https://cks.nice.org.uk/topics/gallstones/

 

 

Review Date                           March 2022

Next Review Date                   March 2023

GP Sifter                                 Dr Laura Vines

Contributor                              Mr Mike Clarke

                                                Mr Paul Peyser

Version                                    2.0