The non-surgical therapy of uncomplicated gallbladder stones: is there a niche?

INTRODUCTION: In Western countries gallstone prevalence is around 10%. 80% are cholesterol stones. The elucidation of their pathophysiology, particularly from the 1970s to the 1990s, led to the development of various non-surgical treatments. The disadvantages of these therapies, together with the development of minimally invasive gallbladder removal, have largely rendered non-surgical approaches obsolete. However, a relatively high proportion of patients who undergo cholecystectomy do not become completely symptom-free. To this end, we address the role of non-surgical therapy for uncomplicated gallbladder stones, which has received little attention in recent decades. AREAS COVERED: Based on extensive research in PubMed we present the pathophysiology of stones, oral litholysis, direct litholysis and shock wave lithotripsy. The role of these treatments to surgery in selective therapy as well as primary and secondary prevention is discussed. Moreover, we allude to the association of cholesterol gallstones with cardiovascular disorders. EXPERT OPINION: Too little is known about when and how gallstones develop and how gallstones respond to preventive measures regarding cardiovascular diseases. Further research is needed for a more individualized therapy - especially with respect to non-surgical approaches - of the rather benign gallstone disease that nevertheless has a high impact on health economics.