Nonsurgical Treatment Options for Gallstones

But how do you get rid of gallstones? Surgery — in this case, a cholecystectomy, or gallbladder removal — is the most common form of treatment for gallstones. But the fact that surgically taking out gallstones requires removing an entire organ has led to a growing interest in gallstone treatment without surgery.

Why Treatment for Gallstones Is Necessary

Besides alleviating symptoms, treatment for gallstones is necessary to avoid a progression that can result in severe conditions, such as acute cholecystitis, the condition in which the gallstone blocks the gallbladder ducts, causing the gallbladder to become inflamed and infected. Patients with acute cholecystitis are usually hospitalized and receive antibiotics, pain medication, and often surgery.

If you do not have symptoms, the most common treatment is to “wait and see,” because the risks outweigh the benefits for both medical and surgical treatments. If you have gallbladder symptoms, surgical treatments are preferred unless you are at high risk, and then drug treatments may be utilized.

“If someone is symptomatic, we do recommend patients get the gallbladder taken out,” says Nikhil Kumta, MD, a gastroenterologist and the director of interventional endoscopy at Mount Sinai Health System in New York City. “[Gallbladder surgery] is minimally invasive, so the risk of complications is low. But if people are unable to go through surgery, if someone is really old or really sick, there are different treatment options.”

Here are six methods for gallstone removal without surgery:

1. Thinning Bile With Acid Pills Can Dissolve Gallstones

In some cases, gallstones can be treated with medicine.

Certain chemicals, such as ursodiol or chenodiol, which have been shown to dissolve some gallstones, are available in oral bile acid pills. These medicines work by thinning the bile, which allows gallstones to dissolve.

While these pills can be effective and are generally well tolerated by patients, medical treatment of gallstones is limited to people whose stones are small and made of cholesterol. But according to Mount Sinai, these drugs can take two years or longer to work, and gallstones may return after treatment ends.

“Decreasing the cholesterol content of the bile can dissolve (certain gallstones), but it’s not effective enough that we don’t refer patients to surgery,” Dr. Kumta says.

2. Small Gallstones May Be Broken Apart With Shock Waves

Another gallstone treatment without surgery for which gallstones must meet certain criteria is extracorporeal shock-wave lithotripsy (ECSWL). Although it is most commonly used to treat kidney stones, it can also be used on gallstones.

This method can only be effective on solitary gallstones that are less than 2 centimeters in diameter, so fewer than 15 percent of patients are eligible for ECSWL. The goal of the treatment is to break up, or fragment, gallstones by sending shock waves through the soft tissue of the body.

However, this form of treatment is rarely used as research has found the results to be unsatisfactory: Only 18 percent of ECSWL patients remain free of symptoms and gallstones, and 72 percent of patients later require gallbladder removal.

3. Gallstones Can Be Dissolved With an MTBE Injection

This nonsurgical treatment option involves injecting a solvent known as methyl tertiary-butyl ether (MTBE) into the gallbladder to dissolve the gallstones. According to research, MTBE rapidly dissolves gallstones — but there can be some serious side effects, such as severe burning pain. As a result, this type of treatment is used very sparingly.

MTBE creates fumes, and if it’s not administered properly in a ventilated area, it could cause severe burning for the patient and operators and even cause electrical fires. This procedure should only be considered in very select cases, and you should inquire about your doctor’s level of experience with performing MTBE before getting this form of treatment.

4. Endoscopic Drainage Follows the Gallbladder’s Natural Path

Endoscopic drainage mimics the healthy route of bile from the gallbladder to the small intestine. An endoscopic transpapillary treatment involves accessing the cystic duct with a camera through the mouth and down the throat. Then a stent, a small tube, is placed through the duct into the gallbladder. It is coiled to imitate the trajectory of the bile out of the small intestine, which is the same process as that of a healthy gallbladder. Kumta says that this form of treatment allows the gallbladder to resume normal bile disposal.

5. Percutaneous Cholecystostomy Is Best for Seriously Ill Patients

This is a nonsurgical treatment option, but it’s most effective when followed by gallbladder removal. Percutaneous cholecystostomy (PC) is typically saved for seriously ill patients who cannot tolerate surgery right away. The procedure involves using a needle to withdraw fluid from the gallbladder and then inserting a catheter through the skin to drain the fluid. The catheter is left in place for a number of weeks, after which gallbladder removal surgery is performed to prevent recurrence.

6. Ultrasound-Guided Procedure to Drain the Gallbladder

Endoscopic ultrasound–guided gallbladder drainage (EUS-GBD) is a procedure for patients who have acute cholecystitis, or gallbladder inflammation, and are unable to have surgery. It involves placing an endoscopic stent between the gallbladder and alimentary tract to drain fluid, also known as transmural drainage.

“Transmural drainage creates a new tract directly through the stomach into the gallbladder,” Kumta says. “This allows the gallbladder to decompress.”

Previously, practitioners would use a plastic stent, but now a mesh-like metal stent, known as a lumen apposing metal stent (LAMS), is more common as it is more effective, per research.

According to a 2023 clinical practice update from the American Gastroenterological Association, EUS-GBD has a success rate of 89 to 98 percent. However, the authors note that only those very skilled in advanced therapeutic endoscopic ultrasound should perform this procedure.

When Considering Treatment Options, Talk to Your Doctor

As a gastroenterologist, Kumta always refers people to a surgeon if they are experiencing pain in their right abdomen so that they can learn the pros and cons of removing the gallbladder.

Still, Kumta says that obesity is correlated with gallstone formation and that patients can make dietary changes, lose weight if they are obese, and opt for a low-fat diet.

If you pick the “change your diet, wait and see” approach, be mindful of the factors that predispose someone to gallstones: You can’t control your age, your gender (women are more prone to gallstones), or your genes.

If you have gallstones, knowing what’s available to remove or otherwise treat them can help you in making your treatment decisions. Discuss these treatment options with your doctor and find the one that’s right for you.

Additional reporting by Calley Nelson.