Background Current cholelithiasis management is laparoscopic cholecystectomy. However, not all patients opt for this approach. Some of them prefer another alternative option, such as litholysis with bile acids (such as ursodeoxycholic acid/UDCA), but the evidence is still scarce.

Methods Medical record data (2019-2023) was screened. Adult patients (>18 years old), ultrasonography (USG) confirmed cholelithiasis, non-diabetes/heart/kidney disease, consumed UDCA, and refusal record of cholecystectomy were retrospectively analyzed. Patients with incomplete follow-up records were excluded. The primary outcome is complete gallstone resolution by USG examination.

Results A total of 88 patients (38 female, 50 male) matched the inclusion criteria. All patients had hypercholesterolemia and consumed statins. The median age was 38±12.30, the median dosage of UDCA 10±0.70 body weight/kg, and the median duration of treatment 9.0±3.3months. The majority (68 patients) have gallstone diameter ≤1cm, and 20 patients have a diameter >1cm. All patients received the same lifestyle modification advice, especially on avoiding fatty foods.

Primary outcome was achieved in 80.7% (71/88) patients while 19.3% (17/88) did not. The majority of patients (67/68) with a stone diameter ≤1cm achieved complete resolution, but only 4 out of 20 patients with a stone diameter >1cm made it.

Multivariate log regression analysis indicates that gallstone diameter affects the outcome (p=0.04). Contrarily, the amount of stone, duration of treatment, age, sex, type of statin, and dosage of UDCA did not (p>0.05). Sub-analysis based on the stone diameter (≤1cm vs. >1cm) showed that smaller size favors the odds for complete stone resolution (Mantel-Haenszel Odds Ratio 5.59 (95% 3.33-7.84; p<0.05)).

There were no reports of serious side effects that caused discontinuation of medication during the study.

Conclusions UDCA treatment may serve as an alternative option for patients with cholelithiasis who have declined surgery.