The effect of ursodiol on the efficacy and safety of extracorporeal shock-wave lithotripsy of gallstones: the Dornier National Biliary Lithotripsy Study

Article Abstract:

Shock-wave lithotripsy has provided, for some patients, a significant improvement over surgery for the treatment of gallstones. Shock waves generated outside the body travel through the soft tissues of the body and strike the firmer gallstones and in some cases are capable of breaking them apart. Although lithotripsy can be effective by itself, it is usually combined with the administration of bile acids, which may help to dissolve the fragments of the shattered gallstones. (It should be remembered that gallstones are usually congealed masses of fatty material, and not mineral 'stones'.) However, until now, there has not been a randomized and controlled study of effectiveness and safety of using bile acids as an adjunct to shock-wave lithotripsy. A major study, involving 600 patients at 10 centers, was designed to determine if the administration of ursodiol, a bile acid, contributes significantly to the effectiveness of the procedure. Gallstones were fragmented in 97 percent of all cases; the fragments were smaller than 5 millimeters in 46.8 percent of the patients. Recurrence of gallstones is a common event, but it was found that 21 percent of the patients who received ursodiol were free of gallstones after six months, in contrast to 9 percent of those who received placebo instead of ursodiol as a part of the lithotripsy procedure. There were few adverse effects of the treatment, but diarrhea occurred in 32.6 percent of the patients treated with ursodiol and in 24.7 percent of the patients treated with placebo. The treatment was more effective for smaller gallstones than larger ones, and was more effective for single stones than multiple stones. Gallstones which had begun to calcify were more resistant to the treatment than those which were transparent on X-ray examination. The study demonstrates that the use of ursodiol significantly contributes to the success of shock-wave lithotripsy among patients with gallstones. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasonic waves, Ultrasonic therapy, Bile acids, Ultrasonic lithotripsy

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Gallstone lithotripsy: Is there still cause for optimism?

Article Abstract:

Gallstone lithotripsy, a noninvasive method of dissolving gallstones by means of high-energy sound waves, was initially hoped to be a ''miracle'' treatment for gallstones. As research results on its use are coming in, many who once held high hopes for the technique are now questioning whether it is of any use at all. A close look at the research results shows that although gallstone lithotripsy is not a miracle cure, it does have a useful place in the treatment of gallstones. The research shows that the biggest predictor of successful use of lithotripsy is effective fragmentation of the stones to a size that is small enough to be passed from the body. This is determined by a combination of factors. The number of shock waves delivered and peak pressures attained for shock waves are two factors of the lithotripsy itself that affect fragmentation. The number of stones and their size and composition are important factors that influence the effectiveness of this treatment. Lithotripsy seems to be highly effective for patients with single stones that are not too large and have a high cholesterol content. Computed tomography can be used to identify which stones have a high cholesterol content. The effectiveness of lithotripsy also hinges on the pathway the wave is directed at, which relies on the skill of the technician. Although lithotripsy is not the miracle cure for gallstones that was initially hoped, its usefulness should not be overlooked. It can provide an effective, noninvasive treatment for selected patients. Refinements in techniques may broaden its use in the future. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gallbladder diseases, editorial

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