The role of extracorporeal shock-wave lithotripsy in the treatment of symptomatic cholelithiasis.

Abstract

OBJECTIVES:

To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and adjuvant bile-salt therapy for the treatment of symptomatic cholelithiasis.

DESIGN:

A prospective case study. Follow-up ranged from 3 to 54 months.

SETTING:

A university teaching hospital.

PATIENTS:

Two hundred and twenty-three patients with symptomatic cholelithiasis, a gallbladder that opacified at oral cholecystography and three or fewer radiolucent stones with a maximum total dimension of 3 cm. Of these patients, 197 were given bile salts (ursodeoxycholic acid or chenodeoxycholic acid, 8 to 10 mg/kg daily) and underwent ESWL. Twenty-eight were excluded because of noncompliance with the protocol or treatment failure before termination of the ESWL procedure.

INTERVENTION:

ESWL with a piezoelectric lithotripter.

MAIN OUTCOME MEASURES:

The success rate of the intervention, the causes of failure, associated complications and the recurrence rate of cholelithiasis.

RESULTS:

Of the 197 patients who underwent ESWL, 85 (43%) were free of stones after treatment. Treatment failure was caused by the following: unsatisfactory fragmentation (9%), increase in fragment size during bile-salt therapy (8%), severe diarrhea due to bile salts (3%), nonvisualization of fragments after the first ESWL (3%), acute cholecystitis (2%), persistence of small fragments at the end of the treatment protocol (2%) and acute pancreatitis (0.5%). Complications included biliary colic (21%), diarrhea (15%), acute cholecystitis (2.5%), acute pancreatitis (2%), macroscopic hematuria (2%), perirenal hematoma (0.5%) and vagal shock (0.5%). The recurrence rate was 18%. Causes of noncompliance with treatment (26%) were the length of treatment, the occurrence of biliary colic during this period and the high cost of bile salts.

CONCLUSION:

ESWL with bile salts as treatment for symptomatic cholelithiasis is not recommended for routine use.

• Authors: Y M Dion, J Morin
• Journal: Canadian journal of surgery. Journal canadien de chirurgie (Can J Surg) Vol. 38 Issue 2 Pg. 162-7 (Apr 1995) ISSN: 0008-428X [Print] Canada
• PMID: 7728671 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Bile Acids and Salts

Topics

• Adult
• Aged
• Aged, 80 and over
• Algorithms
• Bile Acids and Salts (therapeutic use)
• Cholelithiasis (therapy)
• Clinical Protocols
• Female
• Follow-Up Studies
• Humans
• Lithotripsy (adverse effects, methods)
• Male
• Middle Aged
• Prospective Studies
• Recurrence
• Time Factors
• Treatment Failure
• Treatment Outcome
• Treatment Refusal