Primary prevention

People at high risk of gallstones include:

  • Patients (with a gallbladder in situ) who have undergone bariatric surgery and are experiencing rapid weight loss[22]

  • Those receiving parenteral nutrition

  • Those using somatostatin long-term.

Primary prevention starts with preventing gallstones, which entails lifestyle modification: a diet high in fibre and low in saturated fat, and maintenance of a normal body weight, coupled with moderate physical activity.[23][24] The evidence for a preventative effect of healthy lifestyle, diet, regular physical activity, and maintenance of an ideal body weight, however, is weak.[25]

Preventative medical therapy employs ursodeoxycholic acid (UDCA) to lower cholesterol saturation in bile and so lessen the short-term risk of stone formation in obese individuals undergoing rapid weight loss through dietary caloric restriction or bariatric surgery.[22] UDCA has limited value for dissolving established gallstones.[26] This agent is best reserved for the occasional non-surgical candidate with small gallstones who is truly symptomatic.

Secondary prevention

Patients with symptomatic gallstones should be offered elective cholecystectomy to prevent development of acute cholecystitis.

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