Extracorporeal biliary lithotripsy: review of experimental studies and a clinical update

Article Abstract:

Extracorporeal biliary lithotripsy is the disintegration of gallstones by shock waves transmitted from outside the body. A review of studies assessing extracorporeal lithotripsy showed that extracorporeal shock waves can safely fragment the gallstones of 80 to 100 percent of patients. Satisfactory fragmentation results in fragments that are 3 mm to 5 mm in diameter or less. The rate of satisfactory fragmentation varied widely, from 22 to 78 percent, due to differences in characteristics of stones. Of patients with single stones of 20 mm or less in diameter, 90 percent were free of stones within six to nine months after lithotripsy. Bile duct-stone lithotripsy, or fragmentation of stones lodged in the bile duct, is done only when endoscopic or intracorporeal lithotripsy have failed. In endoscopic lithotripsy, fragmentation is carried out via endoscope, a tube-like structure with an optical system inserted into a natural body opening or small incision. Intracorporeal lithotripsy achieves fragmentation through a probe that comes in direct contact with the stone. Results also show that lithotripsy can effectively clear bile ducts that are blocked by stones in 55 to 85 percent of patients. Thus, extracorporeal lithotripsy is a safe and effective procedure for treating patients with biliary stone disease. The role of lithotripsy should increase with the improvement of lithotripsy generators, the addition of techniques for dissolving and extracting stones, and development of therapy to prevent the recurrence of stone formation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Ultrasonic lithotripsy

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Successful outpatient treatment of gallstones with piezoelectric lithotripsy

Article Abstract:

The application of shock waves from outside the body to shatter ''stones'', known as extracorporeal lithotripsy, was first successfully used for kidney stones, saving patients from surgery, although not from anesthesia and hospitalization. Today, new technology makes pain-free lithotripsy possible; the procedure can be done as an outpatient procedure, and is now used against gallstones, as well. This procedure is most effective when it used against a single gallstone 20 mm or less in diameter. The procedure is less effective when the stones are larger or if there is more than one stone. The lithotriptor reduces the stones to fragments that are small enough to pass from the biliary tract. A study was conducted of 38 women and 22 men (average age, 48) with symptoms of gallstones, to evaluate the effectiveness of piezoelectric lithotripsy in disintegrating stones without anesthesia. All fragments were passed in most patients who also received bile salt treatment. Biliary pain did occur within one month after treatment, suggesting that passing the fragments caused the pain. Other treatment for gallstones, such as using drugs to dissolve them, or removing them through a tube inserted into biliary tract (laparoscopic cholecystectomy), or removing the gall bladder with chemicals and various surgical techniques, are also effective, but are considered invasive techniques. Extracorporeal piezoelectric lithotripsy marks a major advance in the treatment of gallstones, the authors assert. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lithotripsy

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