Gallstones & Gallbladder Polyps
WHO TO REFER
Symptomatic gallstones
Stones found on imaging and causing symptoms within the last 12 months
Refer to Upper GI surgical outpatients
Asymptomatic gallstones with no symptoms in the preceding 12 months do not need to be referred
Gallbladder polyps
IF Symptomatic OR >1cm OR Gallstones present
Surgery may be considered due to risk of malignancy
Refer to Upper GI surgical outpatients
Polyps < 1cm that are not referred for surgery should have a repeat USS in 1 year due to risk of malignancy
INVESTIGATIONS PRIOR TO REFERRAL
LFTs
Abdominal USS- attach results to referral
PRIMARY CARE MANAGEMENT
Advise patients to avoid food and drink that triggers their symptoms until gallbladder or gallstones removed – i.e. low fat diet
Acute cholecystitis
Should be admitted as a surgical emergency for early laparoscopic cholecystectomy (within 1 week of diagnosis)
Refer to General Surgery On Call
Suspected retained stones after gallbladder surgery
Check LFTs and amylase
Arrange urgent USS
Consider referral to jaundice clinic or hepatobiliary gastro depending in clinical urgency. MRCP and ERCP will then be arranged.
Note- a dilated CBD post gallbladder surgery on its own is quite common after surgery and not necessarily suggestive of a retained stone.
References
NICE guidelines Gallstone disease: diagnosis and initial management 29th October 2014. Nice.org.uk/guidance/cg188
Mr Paul Peyser and Mr Mike Clarke – Upper GI surgeons Royal Cornwall Hospital Trust