Problems in determining the prognosis of asymptomatic gallstones

Decisions as to whether to perform prophylactic cholecystectomy on patients with asymptomatic gallstones require better information on the rate of development of complications than presently exists. The published data are scanty, are probably applicable only to whites, frequently do not clearly define the symptom status of patients at entry to the study, and contain little information that identifies subgroups with differing prognoses. Efforts to overcome these deficiencies and problems encountered in the design of a new follow-up study are described. In the absence of cholecystograms performed routinely on asymptomatic persons it is difficult to assemble a cohort of patients with silent gallstones suitable for a follow-up study. Other methods of identifying such patients may require that follow-up for the study start later than the time when stones were first demonstrated. Characteristics that should be ascertained at entry include demographic and important clinical features, the number and type of stones and the patient’s symptoms. Follow up should include the various complications of cholelithiasis, and whether cholecystectomy was later performed. All dates on which these significant events occur should be noted.

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