The prevalence of gallbladder stones in adults is approximately 5-25% in Western countries, and it is important to understand the outcomes, complications, and proper treatment options associated with gallbladder stones. Kurinchi et al. from the Royal Free Hospital in the United Kingdom conducted a review of advances related to gallbladder stones, which was published in the April 22, 2014 issue of BMJ. Definition Gallbladder stones are crystals deposited in the gallbladder with a prevalence of approximately 5-25%, with a higher prevalence in Western populations, women, and the elderly. Depending on the composition of the stones, gallbladder stones can be classified as cholesterol stones, bile pigment stones and mixed stones (both cholesterol and bile pigment stones). In recent years, several new classifications have been added based on microscopic analysis of the structure and composition of the stones, but nevertheless, most gallstones are still classified as cholesterol stones (about 37%-86%), bile pigment stones (2%-27%), calcium stones (1%-17%) and mixed stones (4%-16%). Gallbladder stones can be classified according to their cause, prevention, imaging and response to litholytic drugs, but regardless of the classification method, the current guidelines for the management of gallbladder stones are applicable to all types. The formation of gallbladder stones is associated with an altered balance between nucleation and inhibition factors in the bile. The causes that contribute to stone formation are: excess cholesterol in the bile, low levels of bile salts, reduced gallbladder motility, and reduced levels of phosphatidylcholine molecules, the latter organizing cholesterol to form crystals. The main risk factors for cholesterol stones are: female, pregnancy, high estrogen use, aging, race (higher prevalence in Native American Indians and lower prevalence in black Americans and people from China, Japan, India and Thailand), genetics, obesity, high triglyceride levels, low HDL levels, sudden weight loss, high energy diet, refined carbohydrate diet, lack of exercise, cirrhosis of the liver , Crohn’s disease and impaired gallbladder contraction (e.g., after gastrectomy or vagotomy). Hemolysis, chronic bacterial or parasitic infections are often considered to be the main risk factors for cholestasis, but all three of these factors can often be avoided. The most common symptom is biliary colic (pain in the right upper abdomen lasting more than half an hour), usually without fever. If fever is present, it is often indicative of cholecystitis or cholangitis. Other symptoms include epigastric pain and nausea after eating fatty or fried foods, bloating, and frothy and putrid smelling stools. Complications of gallstones include cholecystitis (0.3%-0.4% per year), acute pancreatitis (0.04%-1.5% per year), obstructive jaundice (0.1%-0.4% per year), and less common complications such as acute cholangitis and intestinal obstruction. Among them, acute pancreatitis and cholangitis can be life-threatening complications, with a mortality rate of 3%-20% for the first episode of acute pancreatitis and 24% for acute cholangitis. Other complications can often occur with biliary colic alone, and patients with a history of biliary colic attacks are at higher risk for complications. Although studies have shown an association between gallstones and biliary tract tumors, there is no evidence of a causal relationship, and it is likely that some of the risk factors are the same between them. Prevention Although certain risk factors associated with gallstones such as obesity, sudden weight loss, high energy diet, refined carbohydrate diet, and lack of exercise can be avoided by lifestyle changes, there is no evidence that lifestyle changes are effective in reducing the incidence of gallstones. Early detection of sickle cell anemia, so that appropriate measures can be taken to prevent the occurrence of hemolysis, or prophylactic antibiotics for post-splenectomy patients and patients with splenic infarction to prevent infection and thus prevent the occurrence of gallstones. Another way to prevent gallstones is to remove the gallbladder, for those undergoing bariatric surgery (since sudden weight loss is also a risk factor for gallstone formation) and for patients with symptomatic gallstones. If other major abdominal surgery is required at the same time, the gallbladder can be removed together to avoid further surgery. There is no evidence to support prophylactic cholecystectomy in patients without stones in the gallbladder, and there is no evidence to suggest that the above methods of gallstone prevention are effective.