Chronology of Cholelithiasis

We investigated the natural history of cholelithiasis in 59 samples of stones from the gallbladder or common bile duct in 15 patients, using as a tracer for the timing of stone formation the 14 C released into the environment during nuclear weapons testing. The ages of the stones were correlated with the dates of onset of symptoms and with other clinical data. None of 11 symptomatic patients had symptoms or complications until at least two years (mean ±SD, 8.0±5.1 years) after stone formation began. There was a lag time of 11.7±4.6 years between initial stone formation and cholecystectomy. The growth rates of stones from 11 symptomatic patients and 4 asymptomatic patients were similar (2.6±1.4 and 2.6±1.1 mm per year). Studies of two stones retrieved from the common bile duct showed that one had the same age as a cholecystic stone; the other, removed two years after cholecystectomy, apparently grew in the common bile duct. The long latency period between the formation of gallstones and the onset of symptoms indicates that interruption of the natural progression of gallstone disease is potentially possible with medical therapy. (N Engl J Med 1986;314:1075–7.) SMALL 1 proposed that the formation and progression of cholesterol gallstone disease could be divided into five stages — metabolic, chemical, physical, growth, and symptomatic. To interrupt or reverse the natural progression of gallstone disease, the temporal relations between the stages of calculus formation should be defined, so that appropriate clinical strategies can be planned. We have developed a method to investigate the growth pattern of gallstones and to determine the "latency period" between stone formation and the onset of clinical symptoms. This method uses excess 14 C in the atmosphere, a result of atomic weapons testing, as a marker of the . . .