Natural history of asymptomatic gallstones. A prospective 18-year follow-up

The ready availability of abdominal ultrasonography for the investigation of a wide range of abdominal symptoms has resulted in the increased diagnosis of asymptomatic gallstones. Management of such accidentally discovered gallstones poses a dilemma as conclusive evidence of the benefits of cholecystectomy is lacking. The aim of this study was to understand the natural history of asymptomatic gallstones discovered through a routine patient care process. We followed 109 persons with asymptomatic gallstones. All were then reviewed annually for 18 years for evidence of gallstone-related problems. Results were compared with previous literature studies. Of 109 patients, 73 were women and 36 men, with an average age of 48.2 years (21 - 70). Symptoms developed in 31 patients (28.4%) after an average latency period of 37 months (2 – 98 months). One woman had gallbladder adenocarcinoma, and ten patients underwent prophylactic cholecystectomy. Women were more likely to become symptomatic than men, but symptom development in the men was more serious because initial presentations were biliary complications. Death due to nonbiliary causes occurred in 16 (14.7%) persons. The average age at the time of death was 70 years, ranging from 62 to 83 years. 52 persons remained asymptomatic for 18 years. The yearly risk of biliary pain appears to decrease with the passage of time . Follow-up showed that only 28.4% developed symptomatic gallstones. Most patients with asymptomatic gallstones required no treatment.