Health condition · Clinically reviewed
Gallstones, silent, symptomatic and complicated.
Solid deposits that form in the gallbladder. Common and often silent — but symptomatic and complicated gallstones need investigation and often surgery.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, BSG or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK guidance on gallstone diagnosis, ERCP and laparoscopic cholecystectomy.
Key facts
Gallstones at a glance.
The essentials, in plain English — what they are, how common they are, how they are diagnosed, and how they are treated in the UK today.
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What it is
Crystalline deposits — mostly cholesterol or pigment — that form in the gallbladder or bile ducts.
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How common
Around 10% of UK adults have gallstones; more common with age, female sex and higher BMI.
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Silent majority
Most gallstones cause no symptoms and are found incidentally on imaging.
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The classic pain
Biliary colic — severe right upper quadrant or epigastric pain, often after a fatty meal.
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First-line imaging
Abdominal ultrasound — highly sensitive for stones in the gallbladder.
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Definitive care
Laparoscopic cholecystectomy for symptomatic stones; ERCP for stones in the bile duct.
Why this guide matters
Silent, symptomatic, complicated.
Gallstones behave in three very different ways — the plan depends on which category you fall into, and the three points below shape everything else.
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Silent stones rarely need surgery
Incidental gallstones with no symptoms usually just need reassurance and safety-netting.
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Symptomatic stones deserve a plan
Recurrent biliary colic is a clear indication for laparoscopic cholecystectomy.
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Complications need urgent care
Cholecystitis, cholangitis and gallstone pancreatitis are medical emergencies.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP and surgical team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Symptom history, LFTs and ultrasound
Phase 2 · Confirming
MRCP and therapeutic ERCP for bile-duct stones
Phase 3 · Managing
Endoscopic ultrasound and surgical consult
- 01
Recognising
Symptom history
Pattern, timing and triggers of pain — biliary colic is typically post-prandial, right-sided and lasts hours.
- 02
Recognising
LFTs and amylase
Liver function tests and amylase screen for bile-duct obstruction and gallstone pancreatitis.
- 03
Recognising
Abdominal ultrasound
First-line imaging — highly sensitive for stones, wall thickening and duct dilatation.
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Confirming
MRCP
Magnetic resonance cholangiopancreatography — the non-invasive test if a bile-duct stone is suspected.
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Confirming
ERCP
Endoscopic retrograde cholangiopancreatography — therapeutic removal of stones from the bile duct.
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Managing
Endoscopic ultrasound
For uncertain cases — very high accuracy for small bile-duct stones missed on MRCP.
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Managing
General surgery consult
For planning laparoscopic cholecystectomy or complex biliary intervention.
Typical timeline: 2–6 weeks from first ultrasound to a settled surgical plan.
Symptoms
What gallstones actually feel like.
From vague dyspepsia to full-blown biliary colic — and the red flags that signal a stone has moved into the bile duct.
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Biliary colic
Severe right upper quadrant pain, often post-meal, lasting 30 minutes to several hours.
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Dyspepsia
Bloating, indigestion or fullness after fatty foods — non-specific but common.
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Nausea and vomiting
Often accompanying biliary colic or cholecystitis attacks.
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Jaundice
Yellowing of skin or eyes — suggests a stone obstructing the common bile duct.
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Fever
Suggests acute cholecystitis — inflammation of the gallbladder needing urgent care.
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Chronic RUQ discomfort
Dull, grumbling right-sided upper abdominal ache between colic episodes.
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Pancreatitis
Gallstone-induced pancreatitis — severe epigastric pain radiating to the back.
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Red flag
Severe RUQ pain with fever and jaundice — call 999. Suggests cholangitis or gallstone pancreatitis.
Treatment
How gallstones are treated in the UK.
Matched to whether stones are silent, symptomatic or complicated — from watchful waiting through to emergency surgery.
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Watchful waiting
For asymptomatic stones found incidentally — usually no treatment is needed.
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Analgesia for colic
Paracetamol, NSAIDs or opioids for acute biliary colic pain relief.
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Laparoscopic cholecystectomy
Keyhole removal of the gallbladder — the definitive treatment for symptomatic stones.
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ERCP + sphincterotomy
Endoscopic removal of stones from the common bile duct, often before cholecystectomy.
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Emergency cholecystectomy
Same-admission surgery for acute cholecystitis — the current NICE-endorsed pathway.
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Percutaneous cholecystostomy
A drain into the gallbladder for very unwell patients unfit for immediate surgery.
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Ursodeoxycholic acid
A bile acid that dissolves small cholesterol stones — reserved for specific, selected cases.
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Endoscopic ultrasound + drainage
For complicated cases — advanced therapeutic biliary intervention in specialist centres.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or surgeon knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.
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NICE. Gallstone disease: diagnosis and management (CG188).
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British Society of Gastroenterology. Guidelines on the management of common bile duct stones.
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Royal College of Surgeons of England. Commissioning guide: gallstone disease.
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Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS).
Red flags
When gallstones become an emergency.
Most gallstone attacks are painful but not dangerous. These patterns need urgent assessment — do not delay.
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Charcot’s triad
Fever, jaundice and right upper quadrant pain — cholangitis. A medical emergency.
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Severe pancreatitis
Gallstone pancreatitis with severe epigastric pain and raised amylase — urgent hospital care.
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Gallbladder perforation
A rare but life-threatening complication of acute cholecystitis — needs emergency surgery.
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Empyema of the gallbladder
Pus in an obstructed gallbladder — sepsis risk, needs urgent drainage or surgery.
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Post-cholecystectomy pain
New or persistent pain after surgery — may indicate retained stones or bile-duct injury.
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Retained CBD stone
Persistent jaundice or raised LFTs after cholecystectomy — needs ERCP.
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Recurrent attacks despite diet
Repeated biliary colic — do not delay definitive surgery.
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Pregnancy with gallstones
Symptomatic gallstones in pregnancy need specialist obstetric and surgical review.
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Gallbladder cancer suspicion
A gallbladder mass, porcelain gallbladder or rapid weight loss — urgent specialist referral.
Living with it
Before and after the gallbladder.
Four things that make the biggest difference — diet, weight, life after cholecystectomy, and knowing when to reassess.
A quiet reminder
Do not push through repeat attacks.
Recurrent biliary colic is an indication to plan surgery — waiting risks a much more serious complication.
- 01 Diet
Lower saturated fat, steady meals
Reducing fatty foods and eating regularly can reduce the frequency of biliary colic episodes.
- 02 Weight
Gradual, not rapid, weight loss
Rapid weight loss increases the risk of new stones — aim for steady change with your GP or dietitian.
- 03 Surgery
Life after cholecystectomy
Most people digest normally without a gallbladder; some notice loose stools with fatty meals for a few weeks.
- 04 Reviews
Reassess if symptoms change
New jaundice, fever or severe pain — always seek prompt medical review.
Frequently asked
Everything we get asked about gallstones.
Quick answers on symptoms, ERCP, dissolution therapy, and life after cholecystectomy.
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What are gallstones?
Gallstones are crystalline deposits — usually cholesterol or pigment — that form in the gallbladder or bile ducts. Many cause no symptoms, but some produce pain or serious complications.
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Do all gallstones need treatment?
No. Asymptomatic stones found incidentally on imaging usually need no treatment. Symptomatic stones are typically treated with laparoscopic cholecystectomy.
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What does biliary colic feel like?
A severe, steady right upper quadrant or epigastric pain — often coming on after a fatty meal, lasting from 30 minutes to several hours, sometimes radiating to the right shoulder.
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What is ERCP?
Endoscopic retrograde cholangiopancreatography — an endoscopic procedure that can remove stones from the common bile duct, usually done before or after gallbladder surgery.
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Can gallstones be dissolved with tablets?
Only in a small minority. Ursodeoxycholic acid can dissolve small cholesterol stones over months, but recurrence is common and surgery is usually preferred.
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What life is like after gallbladder removal?
Most people digest normally within weeks. A minority notice looser stools after fatty meals; simple dietary adjustments usually help.