Sauerbruch T. et al., 2026: The non-surgical therapy of uncomplicated gallbladder stones: is there a niche?

Sauerbruch T, Lammert F.
Expert Rev Gastroenterol Hepatol. 2026 May;20(5):409-424. doi: 10.1080/17474124.2026.2656233. Epub 2026 Apr 15.

Abstract

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.

Comment Hns-Göran Tiselius

Ever since the first successful treatment of kidney stones with SWL was reported in the early 1980ies, the question repeatedly asked is whether the same or a similar approach might be applicable for gallbladder stones.

The current review on non-surgical/non-invasive methods for gallbladder stones gives an extensive answer to this question. With few exceptions the bottom-line of this review is, that in view of the success with laparoscopic/video-endoscopic cholecystectomy, the need of other low/non-invasive methods is very low.

There is a lot of information in this article on factors of importance for gallbladder stone formation. For the interested reader there is extensive information in this regard as well as on the metabolism of cholesterol and bile acids. Of particular interest is the possibility to give medical dissolution after SWL. For this kind of treatment only few and selected patients might qualify. Of note is that in terms of oral dissolution only ursodeoxycholic acid is useful. Such an approach might be applicable for very selected patients.

Theoretically direct contact dissolution is an alternative, but the authors emphasize that there is insufficient expertise for common use of  such a method.

The conclusion of this extensive review is that with laparoscopic cholecystectomy, most problems with gallbladder stones can be managed with low surgical risk.

The use of SWL for difficult-to-treat common bile duct stones is mentioned in the article. This is a small niche in which the reviewer has some experience [1].

Reference

1. E Lindström , K Borch, E P Kullman, H G Tiselius, I Ihse

Extracorporeal shock wave lithotripsy of bile duct stones: a single institution experience. Gut 1992 Oct;33(10):1416-20. doi: 10.1136/gut.33.10.1416.

Hans-Göran Tiselius