Gallstones found by chance on a scan: what next

What "found by chance" means

NICE calls these asymptomatic gallstones: stones found on scans done for reasons unrelated to gallstone disease, in people who have had no symptoms for at least 12 months before the finding. (NICE CG188) MedlinePlus says gallstones are often found during imaging tests for other health conditions, and that without symptoms you usually do not need treatment. (MedlinePlus)

What guidance says

NICE CG188 (2014): reassure people with asymptomatic gallstones in a normal gallbladder and normal bile ducts that they do not need treatment unless they develop symptoms. (NICE CG188)
Stones in the bile duct are a separate case: NICE handles stones in the common bile duct differently, whether or not they cause symptoms. Your doctor explains which one your report describes. (NICE CG188)
NHS (2025): you might not need any treatment if gallstones are not causing symptoms, and you may need follow-up appointments to check they are not getting worse or causing problems. (NHS)
Cochrane review (2007): found no randomised trials comparing removal of the gallbladder with no removal for silent gallstones, so the usual approach rests on observational studies. (Cochrane 2007)
ACR 2013 white paper: the American College of Radiology paper on gallbladder and bile duct findings seen by chance on CT and MRI. (ACR 2013)

Repeat scans

NICE gives no schedule of repeat scans for gallstones without symptoms; its advice for them is reassurance unless symptoms start. (NICE CG188) This differs from a gallbladder polyp found by chance, where several bodies set ultrasound follow-up by size.

How often symptoms start later

A 2026 meta-analysis of 8 cohort studies with 25,924 people whose gallstones were found by chance gave these shares with symptoms over time: (Alzoubi 2026)

Silent gallstones that went on to cause symptoms (pooled estimate)
Years after the finding	Share with symptoms
5 years	10%
10 years	19%
15 years	26%

The authors put this at about 2 in 100 people a year, in line with the 1% to 4% a year reported before. (Alzoubi 2026)

Symptoms that mean contacting a doctor

The NHS says gallstone pain may be severe and constant, last from 30 minutes to several hours, sit in the middle of the tummy or just under the ribs on the right, and come with feeling sick or vomiting. (NHS)

Urgent GP appointment or NHS 111: tummy pain that lasts longer than 30 minutes. (NHS)
999 or A&E: sudden, severe tummy pain; pain that spreads to the back with vomiting; a very high temperature or feeling hot, cold or shivery; or yellow skin or whites of the eyes. (NHS)

MedlinePlus lists nausea, vomiting, or pain in the abdomen, back or just under the right arm as signs of a gallstone attack, often after eating. (MedlinePlus)

Situations sources single out

Calcified (porcelain) gallbladder. A 2013 review notes it has long been seen as a gallbladder cancer risk; one systematic review found cancer in 15% of such cases, while two smaller case series found none. (Pilgrim 2013)
A gallbladder polyp as well. A 2025 review says stones together with polyps raise the concern for cancer, especially single large polyps in people over 60 in India. (Sasmal 2025) Polyp follow-up is on the gallbladder polyp page.
Very large stones and some health conditions. The same review lists large single stones, sickle cell disease and other blood disorders that break down red cells, a weakened immune system, and people waiting for an organ transplant as groups where the plan is considered one by one. (Sasmal 2025)
Regions with more gallbladder cancer. The review says that in places such as India and Chile, where gallbladder cancer is more common, the threshold for acting may be lower. (Sasmal 2025)

These are points for a specialist to weigh with you, not a screening schedule.

Other things on the same report

Scans of the abdomen often show more than one finding. See liver lesion found by chance, fatty liver seen by chance and, if blood tests were done, liver function test results. Gallstones found by chance do not change the routine screenings for your age.

Where they differ:

Follow-up. NICE recommends reassurance with no treatment unless symptoms start and sets no follow-up; the NHS page says you may have follow-up appointments to check the stones. (NICE CG188)(NHS)
Who is "high risk". NICE names no subgroups for stones without symptoms; the 2025 review lists several groups and regions where the plan may differ. (NICE CG188)(Sasmal 2025)
Porcelain gallbladder. One systematic review found a high cancer rate; two smaller case series found none, so how much it matters is still debated. (Pilgrim 2013)
Evidence. No randomised trials compare acting with watching, so recommendations rest on cohort studies. (Cochrane 2007)(Alzoubi 2026)

Your doctor decides what your result means for you.

Questions people ask

Do gallstones found by chance need treatment?

NICE says people with gallstones that cause no symptoms, in a normal gallbladder and normal bile ducts, do not need treatment unless they develop symptoms. (NICE CG188)

How often do silent gallstones start causing symptoms?

A 2026 meta-analysis of 8 cohort studies found about 10% had symptoms by 5 years, 19% by 10 years and 26% by 15 years, about 2 in 100 people a year. (Alzoubi 2026)

Will I have repeat scans?

NICE does not set a scan schedule for stones without symptoms. The NHS says you may have follow-up appointments to check the stones are not getting worse. (NICE CG188) (NHS)

What symptoms mean I should contact a doctor?

The NHS lists tummy pain lasting longer than 30 minutes for an urgent GP or NHS 111 appointment, and sudden severe pain, pain spreading to the back with vomiting, a very high temperature or yellow skin or eyes for 999 or A&E. (NHS)

Are gallstones common?

Yes. The NHS says gallstones are common and often cause no symptoms, and MedlinePlus says they are often found during imaging tests for other conditions. (NHS) (MedlinePlus)