Gallstone disease in pregnancy

: The incidence of gallstone disease in Japan has increased in recent several decades, and this is associated with the increased fat intake, especially for cholesterol stones. Women are more likely to develop gallstones than men. This sex-related difference in incidence is thought to be related with pregnancy. There are several reports that suggest the lithogenicity of estrogen which increases the content of cholesterol in bile. And there are another reports that gallbladder emptying becomes poor during pregnancy because of the effect of progesterone. The management of gallstone disease in pregnancy is different at the stages of pregnancy, severity of attack, and the presence of infection. The gallstone attack should be treated supportively during pregnancy, especially at the early stage and late stage. And after delivery, cholecystectomy should be performed. As for recurrent attacks, severe attacks or attacks associated with infection, cholecystectomy should be considered even during pregnancy. In the middle stage of pregnancy, cholecystectomy can be performed safely. In the case in which cholecystectomy should be avoided, percutaneous transhepatic biliary drainage can be performed. The common bile duct stone, cholangitis and biliary pancreatitis should be diagnosed be ERCP, and after definitive diagnosis, treatment with endoscopic sphincterotomy should be tried.