Skip to main content
NCBI home page
Gut logoLink to Gut
. 1993 Feb;34(2):274–278. doi: 10.1136/gut.34.2.274

Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

A Elewaut 1, A Crape 1, M Afschrift 1, W Pauwels 1, M De Vos 1, F Barbier 1
PMCID: PMC1373984  PMID: 8432485

Abstract

During a period of 24 months 693 consecutive patients with symptomatic gall bladder stones (526 males, 167 females; mean age 51 years, range 18-89) were treated by extracorporeal shock wave lithotripsy with a Piezolith 2300. The procedure was carried out on an out-patient basis without analgesics or sedatives. Concomitant chemolitholytic treatment (ursodeoxycholic and chenodeoxycholic acid 7.5 mg/kg/day each) was administered until three months after total fragment clearance for a maximum therapy period of 1.5 years. In 601 patients with radiolucent stones complete clearance of all fragments was obtained after three, six, 12, and 18 months in respectively 20, 41, 64, and 78%. Actuarial analysis of the subgroups according to the stone mass (size and number) selected an ideal patient population with solitary stones less than 20 mm diameter (84% stone free after one year). The results are significantly less good when the greater the number of stones or their maximal diameter increases. Treatment was interrupted in 3.6% of the patients. In 90 sludge or fragments remain present. Twenty five patients were lost to follow up for non-biliary reasons. Stone recurrence was 5.7% at one year and was observed both in patients with solitary and multiple stones. A cost effectiveness analysis suggests that laparoscopic cholecystectomy is the most effective and economic solution, although extracorporeal shock wave lithotripsy for solitary radiolucent stones less than 2 cm is cheaper than conventional cholecystectomy. Extracorporeal shock wave lithotripsy for multiple stones is the most expensive and least effective option.

Full text

PDF
274

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brink J. A., Simeone J. F., Mueller P. R., Saini S., Tung G. A., Spell N. O., Ferrucci J. T. Routine sonographic techniques fail to quantify gallstone size and number: a retrospective study of 111 surgically proved cases. AJR Am J Roentgenol. 1989 Sep;153(3):503–506. doi: 10.2214/ajr.153.3.503. [DOI] [PubMed] [Google Scholar]
  2. Burnett D., Ertan A., Jones R., O'Leary J. P., Mackie R., Robinson J. E., Jr, Salen G., Stahlgren L., Van Thiel D. H., Vassy L. Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones. A national multicenter study. Dig Dis Sci. 1989 Jul;34(7):1011–1015. doi: 10.1007/BF01536365. [DOI] [PubMed] [Google Scholar]
  3. Coleman A. J., Saunders J. E. A survey of the acoustic output of commercial extracorporeal shock wave lithotripters. Ultrasound Med Biol. 1989;15(3):213–227. doi: 10.1016/0301-5629(89)90066-5. [DOI] [PubMed] [Google Scholar]
  4. Dubois F., Icard P., Berthelot G., Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990 Jan;211(1):60–62. doi: 10.1097/00000658-199001000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ell C., Kerzel W., Heyder N., Becker V., Hermanek P., Domschke W. Piezoelectric lithotripsy of gallstones. Lancet. 1987 Nov 14;2(8568):1149–1150. doi: 10.1016/s0140-6736(87)91576-5. [DOI] [PubMed] [Google Scholar]
  6. Ell C., Kerzel W., Heyder N., Günter E., Rödl W., Flügel H., Domschke W. Piezoelektrische Lithotripsie von Gallensteinen. Erste klinische Erfahrungen. Dtsch Med Wochenschr. 1988 Sep 30;113(39):1503–1507. doi: 10.1055/s-2008-1067841. [DOI] [PubMed] [Google Scholar]
  7. Ell C., Kerzel W., Langer H., Heyder N., Foerster E., Domschke W. Fragmentation of biliary calculi by means of extracorporeally generated piezoelectric shock waves. Dig Dis Sci. 1989 Jul;34(7):1006–1010. doi: 10.1007/BF01536364. [DOI] [PubMed] [Google Scholar]
  8. Ell C., Kerzel W., Schneider H. T., Benninger J., Wirtz P., Domschke W., Hahn E. G. Piezoelectric lithotripsy: stone disintegration and follow-up results in patients with symptomatic gallbladder stones. Gastroenterology. 1990 Nov;99(5):1439–1444. doi: 10.1016/0016-5085(90)91173-4. [DOI] [PubMed] [Google Scholar]
  9. Flick A. L. Restraint urged for biliary lithotripsy. Dig Dis Sci. 1990 Jul;35(7):916–918. doi: 10.1007/BF01536810. [DOI] [PubMed] [Google Scholar]
  10. Katz S. Biliary lithotripsy: more questions than answers. The ACG Committee on FDA-Related Matters. Am J Gastroenterol. 1990 May;85(5):497–509. [PubMed] [Google Scholar]
  11. Lanzini A., Jazrawi R. P., Kupfer R. M., Maudgal D. P., Joseph A. E., Northfield T. C. Gallstone recurrence after medical dissolution. An overestimated threat? J Hepatol. 1986;3(2):241–246. doi: 10.1016/s0168-8278(86)80033-2. [DOI] [PubMed] [Google Scholar]
  12. Miller T. A. Laparoscopic cholecystectomy: passing fancy or legitimate treatment option? Gastroenterology. 1990 Nov;99(5):1527–1529. doi: 10.1016/0016-5085(90)91190-h. [DOI] [PubMed] [Google Scholar]
  13. Perissat J., Collet D. R., Belliard R. Gallstones: laparoscopic treatment, intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy--a personal technique. Endoscopy. 1989 Dec;21 (Suppl 1):373–374. doi: 10.1055/s-2007-1012994. [DOI] [PubMed] [Google Scholar]
  14. Podda M., Zuin M., Battezzati P. M., Ghezzi C., de Fazio C., Dioguardi M. L. Efficacy and safety of a combination of chenodeoxycholic acid and ursodeoxycholic acid for gallstone dissolution: a comparison with ursodeoxycholic acid alone. Gastroenterology. 1989 Jan;96(1):222–229. doi: 10.1016/0016-5085(89)90784-1. [DOI] [PubMed] [Google Scholar]
  15. Ponchon T., Barkun A. N., Pujol B., Mestas J. L., Lambert R. Gallstone disappearance after extracorporeal lithotripsy and oral bile acid dissolution. Gastroenterology. 1989 Aug;97(2):457–463. doi: 10.1016/0016-5085(89)90083-8. [DOI] [PubMed] [Google Scholar]
  16. Reddick E. J., Olsen D. O. Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc. 1989;3(3):131–133. doi: 10.1007/BF00591357. [DOI] [PubMed] [Google Scholar]
  17. Riemann J. F., Adamek H. E., Weber J. Piezoelectric lithotripsy in the treatment of symptomatic gallstone patients. A 12-month follow-up. J Clin Gastroenterol. 1991 Aug;13(4):395–400. doi: 10.1097/00004836-199108000-00007. [DOI] [PubMed] [Google Scholar]
  18. Sackmann M., Delius M., Sauerbruch T., Holl J., Weber W., Ippisch E., Hagelauer U., Wess O., Hepp W., Brendel W. Shock-wave lithotripsy of gallbladder stones. The first 175 patients. N Engl J Med. 1988 Feb 18;318(7):393–397. doi: 10.1056/NEJM198802183180701. [DOI] [PubMed] [Google Scholar]
  19. Sackmann M., Ippisch E., Sauerbruch T., Holl J., Brendel W., Paumgartner G. Early gallstone recurrence rate after successful shock-wave therapy. Gastroenterology. 1990 Feb;98(2):392–396. doi: 10.1016/0016-5085(90)90830-t. [DOI] [PubMed] [Google Scholar]
  20. Sackmann M., Pauletzki J., Sauerbruch T., Holl J., Schelling G., Paumgartner G. The Munich Gallbladder Lithotripsy Study. Results of the first 5 years with 711 patients. Ann Intern Med. 1991 Feb 15;114(4):290–296. doi: 10.7326/0003-4819-114-4-290. [DOI] [PubMed] [Google Scholar]
  21. Schachler R., Bird N. C., Sauerbruch T., Frost E. A., Sackmann M., Paumgartner G., Johnson A. G. Extracorporeal shock wave lithotripsy of gall stones: an in vitro comparison between an electrohydraulic and a piezoceramic device. Gut. 1991 Mar;32(3):312–315. doi: 10.1136/gut.32.3.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schneider H. T., Fromm M., Ott R., Janowitz P., Swobodnik W., Neuhaus H., Ell C. In vitro fragmentation of gallstones: comparison of electrohydraulic, electromagnetic and piezoelectric shockwave lithotripters. Hepatology. 1991 Aug;14(2):301–305. [PubMed] [Google Scholar]
  23. Schoenfield L. J., Berci G., Carnovale R. L., Casarella W., Caslowitz P., Chumley D., Davis R. C., Gillenwater J. Y., Johnson A. C., Jones R. S. The effect of ursodiol on the efficacy and safety of extracorporeal shock-wave lithotripsy of gallstones. The Dornier National Biliary Lithotripsy Study. N Engl J Med. 1990 Nov 1;323(18):1239–1245. doi: 10.1056/NEJM199011013231804. [DOI] [PubMed] [Google Scholar]
  24. Villanova N., Bazzoli F., Taroni F., Frabboni R., Mazzella G., Festi D., Barbara L., Roda E. Gallstone recurrence after successful oral bile acid treatment. A 12-year follow-up study and evaluation of long-term postdissolution treatment. Gastroenterology. 1989 Sep;97(3):726–731. doi: 10.1016/0016-5085(89)90644-6. [DOI] [PubMed] [Google Scholar]
  25. Way L. W. Changing therapy for gallstone disease. N Engl J Med. 1990 Nov 1;323(18):1273–1274. doi: 10.1056/NEJM199011013231810. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES