Gall stones

If you’re experiencing symptoms of biliary colic, your healthcare provider will investigate with blood tests and imaging tests. Blood tests can detect inflammation, infection or jaundice. They can also give your healthcare provider clues about which organs are being affected. Imaging tests will help locate the source of the blockage. They will usually start with an ultrasound.

Ultrasound: An abdominal ultrasound is a simple and noninvasive test that requires no preparation or medication. It’s usually all that’s needed to locate gallstones. However, it doesn’t visualize the common bile duct very well. If your healthcare provider suspects there’s a gallstone hidden in there, they might need to use another type of imaging test to find it.

MRCP: Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI that specifically visualizes the bile ducts. It’s non-invasive and creates very clear images of your biliary system, including the common bile duct. Your provider might use this test first to find a suspected gallstone there. But if they’re already pretty sure it’s there, they might skip it and go straight to an ERCP.

ERCP: ERCP stands for endoscopic retrograde cholangiopancreatography. This test is a little more invasive, but it’s a useful one for finding gallstones because it can also be used to remove them from the ducts if they are stuck there. It uses a combination of X-rays and endoscopy, which means passing a tiny camera on the end of a long tube down your throat and into your upper GI tract. (You’ll have medication to make this easier.)

When the camera (endoscope) reaches the top of your small intestine, your healthcare provider will slide another, smaller tube into the first one to reach farther down into your bile ducts. They will inject a special dye through the tube and then take video X-rays (fluoroscopy) as the dye travels through the ducts. They can insert tools through the tube to remove the stones they find.

Most people with gallstones will never need treatment. But if your gallstones cause problems, your healthcare provider will want to remove them. Usually, they will want to remove all of your gallstones, even if only one of them is currently causing trouble. If a blockage happens once, it’s likely to happen again. The risk isn’t worth waiting around for.

Since there’s no way to access the gallstones inside your gallbladder without removing it, the standard treatment for problematic gallstones is to remove the gallbladder entirely. This is a minor surgery, and you can live well without a gallbladder. If you have gallstones in your bile ducts, your healthcare provider will have to remove those separately as well.

Can gallstones go away without surgery?

Gallstones in your bile ducts that aren’t stuck can successfully pass through them and into your intestines. You can pass them out through your poop. That's a lucky scenario, but in general, you don’t want to risk having gallstones in your bile ducts in the first place. If they don’t pass all the way out of you, they will only grow bigger over time.

There are some medications that can help to dissolve smaller gallstones. These take many months to work, so they aren’t the most practical option for people experiencing symptoms. But they offer an alternative for people who may not be in a safe health condition for surgery. They may also be practical for people who have gallstones but don’t have symptoms yet.

How are gallstones removed?

There are a few different ways to remove gallstones.

Endoscopy

Gallstones in your bile ducts are removed by endoscopy (ERCP). This doesn’t require any incisions. The gallstones come out through the long tube that’s been passed down your throat. Gallstones in your gallbladder are removed by removing the gallbladder (cholecystectomy). This can usually be done by laparoscopy, a minimally-invasive surgery technique.

Laparoscopy

A laparoscopic cholecystectomy uses small, “keyhole incisions” in your abdomen to operate with the aid of a small camera called a laparoscope. Your surgeon inserts the laparoscope through one keyhole and removes your gallbladder through another. Smaller incisions make for less post-operative pain and a faster recovery time than conventional, “open” surgery.

Open surgery

Some people may have more complicated conditions that require open surgery to manage. If you have open surgery, you’ll have a longer hospital stay afterward and a longer recovery at home for your larger incision. Some laparoscopic cholecystectomies may need to convert to open surgery if your surgeon runs into complications during the procedure.