How should I manage a patient with asymptomatic gallstones in primary care?

Management of a patient with asymptomatic gallstones in primary care:

• Reassure the patient that no treatment is needed unless symptoms develop, as asymptomatic gallstones are common and usually do not cause problems.
• Explain that prophylactic treatments, including prophylactic cholecystectomy, are not recommended because the risks of surgery outweigh the potential benefits in asymptomatic cases.
• Advise the patient to seek medical advice if they develop symptoms suggestive of gallstone complications, such as biliary colic, jaundice, or signs of infection.
• Consider referral if asymptomatic gallstones are found in the common bile duct due to the higher risk of serious complications; these patients should be referred for bile duct clearance and laparoscopic cholecystectomy.
• Prophylactic cholecystectomy may be considered only in rare cases such as a partially calcified 'porcelain' gallbladder due to the increased risk of gallbladder carcinoma.
• There is no role for ursodeoxycholic acid in asymptomatic gallstones because of limited efficacy and high recurrence rates.

Overall, the main approach in primary care is reassurance and watchful waiting, with referral reserved for specific high-risk situations or symptom development.

References: NICE CKS,NICE CG188