Extracorporeal shock wave lithotripsy of calcified gallstones

Article Abstract:

Gallstones which cause discomfort to the patient are often removed surgically, which requires a hospital stay. A nonsurgical procedure called extracorporeal shock wave lithotripsy (ESWL) is being used on an outpatient basis to break up gallstones so they can pass out of the gallbladder. It has been thought that patients with calcified gallstones (containing calcium) are not eligible for this procedure. ESWL was performed on 38 symptomatic patients with calcified gallstones, and the results were compared with 162 patients with noncalcified gallstones who underwent the same procedure. Fragmentation of the stones was considered successful if they were reduced to 3mm or smaller. Six of the patients reached this goal in one treatment session, and 22 patients needed an average of four treatments. The remaining patients are still being treated. Only three of the subjects where clear of fragments by the eighteenth week after treatment; the clearance rate is much higher for patients with noncalcified stones. Two patients required surgery to remove the gallbladder because of a complication of the procedure; both patients developed acute pancreatitis (inflammation of the pancreas) and showed gallstone fragments in the common bile duct when ultrasound imaging was performed. Two-thirds of the group with noncalcified gallstones needed an average of 2.7 ESWL treatments to successfully fragment their gallstones. Patients with calcified stones will ultimately need a more rigorous lithotripsy protocol than patients without calcified stones to achieve this rate of success. The patients with calcified stones also had an increased risk of developing side effects such as acute pancreatitis and hematuria (transient blood in the urine). (Consumer Summary produced by Reliance Medical Information, Inc.)

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Percutaneous extraction of gallstones in 20 patients

Article Abstract:

Nonsurgical treatment of gallstones using extracorporeal shock-wave lithotripsy (ESWL) is currently limited to cases involving noncalcified cholesterol stones below a certain size and number. A number of patients with gallstones not fitting this category either cannot undergo or else refuse surgical removal of the gallbladder (cholecystectomy). This study examines a new procedure for treating gallstones in patients ineligible for ESWL known as percutaneous cholecystolithotomy (PCL). This procedure involves reaching the gallbladder with a catheter, making an insertion into the gallbladder, and removing the stones. It requires the use of ultrasonography (US) and fluoroscopy to visualize the procedure. It also only requires the use of local anaesthesia. This study examined the use of PCL to treat 20 patients with gallstones. Stones were successfully removed from 17 of the 20 patients, with complete removal accomplished in one session for 11 of the patients, and in two sessions for six of the patients. A few minor complications resulted from the procedure. Inserted drains could be removed in 10 of the patients within three weeks, with a longer period of time required in seven patients who were older. At six-month follow-up examinations, no stones were found in the 17 patients. These results show PCL to be a safe and effective treatment for gallbladder stones not suitable for treatment with ESWL. Because gallstones recur at a high rate, surgical removal of the gallbladder is a more effective permanent treatment, but the complications and death rate of that procedure make it unsuitable for a number of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Gallbladder diseases, Cholecystectomy

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Extracorporeal shock wave lithotripsy of gall bladder stones: a pessimistic view

Article Abstract:

Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive technique using high-energy sound waves to break up kidney stones. It has been hoped that it could also be used to treat gallstones in place of surgery. The usefulness of this technique as well as surgery and some other techniques has been followed at the Methodist Hospital of Indiana. ESWL seems to provide little or no benefit in the treatment of gallstones. The standard treatment for gallstones has been surgical removal in patients who exhibit symptoms. Surgery (cholecystectomy) has a strong history of safety and effectiveness and any new treatments must be judged against it. Studies on the effectiveness of ESWL in treating gallstones have shown a low success rate, a large rate of repeat treatments, and a large percentage of patients developing complications. There is also a high probability of repeat stones, since the gallbladder is not removed. The group of patients thought most likely to benefit from ESWL are the elderly or other people who are at risk from general anesthesia for surgery. A new surgical technique, percutaneous cholecystostomy (PCCL), has been developed that only requires local anesthesia. It has been shown to be a much more effective treatment than ESWL and just as safe. ESWL may also be more expensive in the long run. The continued requirement for medication, the recurrence of stones, and the possible need for surgery later on may make ESWL more costly. The indications are that standard gallstone surgery with the alternative treatment of PCCL render ESWL of minor significance in the treatment of gallstones. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial, Gallbladder, Lithotripsy

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