Evidence Is Needed in Support of the Indication

The article provides a clear overview of the current consensus regarding the diagnostic evaluation and therapy of gallstone disease (1). As a general practitioner who has been using sonography for many years and has therefore been confronted with the very common gall bladder/gallstone diseases, I am somewhat surprised about the statement that cholecystectomy is indicated in asymptomatic gallstones >3 cm, polyps >1 cm, and porcelain gallbladder. Polyps >1 cm are rather rare, to date I have never come across any. Gallstones >3 cm I have seen, porcelain gallbladder only rarely. More than 40 years ago, before the use of internal medical abdominal sonography became widespread, the scientific consensus was that all patients carrying gallstones—which at that time usually were symptomatic—should undergo cholecystectomy because of an increased risk of cancer (of the gall bladder or common bile duct?). Subsequently this indication was no longer mentioned in medical discussions or the literature, but it has now resurfaced for large gallstones, again without any evidence (such as cited references or the authors’ own data). Why draw the limit at >3 cm?

The authors should provide evidence to support their indication for cholecystectomy primarily in gallstones >3cm but also in polyps >1 cm and porcelain gallbladder (all asymptomatic), because this statement means that more patients should be advised to undergo cholecystectomy.