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Approach to the patient with incidental gallstones

Nezam H Afdhal, MD, FRCPI
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


The presence of gallstones (cholelithiasis) is common, particularly in Western populations. In the United States, gallstones are seen in approximately 6 percent of men and 9 percent of women [1]. Most individuals with gallstones are asymptomatic throughout their life and are referred to as having "incidental" gallstones. "Uncomplicated" gallstone disease is present if the gallstones cause symptoms (eg, biliary colic). Patients with gallstones, particularly those with uncomplicated gallstone disease, are at risk of developing complications such as acute cholecystitis, cholangitis, or gallstone pancreatitis.

This topic will review the approach to the patient with incidental gallstones. The epidemiology and risk factors for gallstone disease and the approach to patients with symptomatic gallstones or with complications of gallstone disease (such as cholecystitis and pancreatitis) are discussed separately. (See "Epidemiology of and risk factors for gallstones" and "Uncomplicated gallstone disease in adults" and "Acute cholecystitis: Pathogenesis, clinical features, and diagnosis" and "Choledocholithiasis: Clinical manifestations, diagnosis, and management" and "Clinical manifestations and diagnosis of acute pancreatitis" and "Etiology of acute pancreatitis", section on 'Gallstones'.)

The discussion that follows is generally consistent with guidelines from the National Institute for Health and Care Excellence (NICE) [2].


Epidemiologic data on the prevalence of gallstones are available from studies of European, American, and Asian populations [1,3,4]. These studies have revealed a marked variation in overall gallstone prevalence between different ethnic populations. As a general rule, the prevalence of gallstones is higher in Western Caucasian, Hispanic, and Native American populations than in Eastern European, African American, and Asian populations. Some risk factors for gallstones include female sex, older age, and pregnancy (table 1). The epidemiology and risk factors for gallstones are discussed in detail elsewhere. (See "Epidemiology of and risk factors for gallstones".)


While the majority of patients with incidental gallstones will not develop symptoms attributable to the gallstones, approximately 15 to 25 percent will become symptomatic during up to 10 to 15 years of follow-up [5-9]. Patients who develop symptoms typically report biliary colic rather than symptoms associated with the complications of gallstone disease (such as cholecystitis, pancreatitis, and choledocholithiasis). (See "Uncomplicated gallstone disease in adults", section on 'Clinical features'.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2016.
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