Shock wave lithotripsy of gallstones: results and 12-month follow-up in 174 patients

Article Abstract:

Extracorporeal shock wave lithotripsy (ESWL) is a relatively new technique used to treat gallstones. It involves using shock waves to fragment the stone so that it can be cleared from the body. In a previous report, the use of the drug ursodeoxycholic acid (UDCA) with ESWL was examined to see if it improved the results of ESWL. After six months, no differences in stone clearance were seen between patients who received UDCA and those who received a placebo (inactive substance). The current article discusses results from these same patients at 12 months after treatment. Results were from 174 patients who underwent ESWL for gallstones, 87 of whom also received UDCA and 87 of whom received a placebo. Stones were noncalcified in 149 patients and partially calcified in 25 patients. Results showed that at 12 months, three patients who were stone-free at six months had a recurrence of stones. Of the 77 patients who had non-calcified stones and who were treated with UDCA, 18 of 50 (36 percent) who returned for follow-up were stone-free. Of 72 patients with noncalcified stones and treated with a placebo, 11 of 47 (23 percent) who returned for follow-up were stone-free. In the 25 patients with calcified gallstones, 10 were treated with UCDA and 15 with a placebo. Only one patient from both groups was stone-free at 12 months. When stone number and size were also factored in, patients with a single, noncalcified stone with a diameter of 20 millimeters or less had the highest stone-free rates (60 percent). This was significantly higher than for the same group of patients receiving a placebo (33 percent). These results indicate that for selected patients with gallstones, ESWL supplemented with UCDA is more effective than ESWL alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage

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Extracorporeal shock wave lithotripsy of gallstones: results and 6-month follow-up in 141 patients

Article Abstract:

Extracorporeal shock wave lithotripsy (ESWL) utilizes shock waves to crush stones in organs in the body. It was initially developed for treating kidney stones, but is also now being used to treat gallstones. This study examined the initial and long-term effectiveness of ESWL in treating gallstones in 141 patients both initially and after six months. Of the 141 patients, 120 had noncalcified gallstones and 21 had partially calcified gallstones. The subjects either received ursodeoxycholic acid (UCDA) or a placebo; UCDA is thought to be a useful adjunctive therapy to ESWL. Three groups were involved: 62 patients with noncalcified stones and UCDA, 58 patients with noncalcified stones receiving a placebo, and 21 patients with partially calcified gallstones who received either UCDA or placebo. Eighteen percent of the patients were retreated after six weeks from the initial treatment. The stone-free rates after the six-month follow-up were 29 percent in the first group, 24 percent in the second group, and 6 percent in the third. The drug UCDA was not found to have an effect on treatment success. Success was correlated to initial size of the stones. In patients with initial stone sizes of less than 20 mm, the success rates were 40 percent in the first group and 32 percent in the second, significantly better than results in patients with larger gallstones. No adverse effects such as liver injury or pancreatitis were seen in any patient during the six-month follow-up. The results indicate that this technique is safe and somewhat effective, depending on the size and number of gallstones present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Lithotripsy

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Gallbladder lithotripsy

Article Abstract:

Approximately 20 million people in the United States have gallstones, and approximately half a million patients per year undergo surgery to remove their gall bladder. Although this surgery is highly successful, physicians have begun to evaluate alternative procedures that can be used on a nonemergency basis. The use of extracorporeal shock wave lithotripsy (ESWL), the application of strong bursts of shock energy to break apart the gallstones into fragments small enough to pass through the ducts of the bile system, has become an important, noninvasive alternative to surgery. The Crawford W. Long Hospital of Emory University has completed an experiment the Dornier MPL-9000 gallbladder lithotripsy equipment. The procedure proved to be more difficult and complex than a conventional kidney lithotripsy. It is recommended that the procedure should be carried out by a team approach which includes a clinician and an expert radiologist.

Case studies, Surgery, Biliary tract diseases, Calculi

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