Piezoelectric lithotripsy for gallstones: Analysis of results in patients with extended selection

Author:

Darzi A1,El-Sayed E1,O'Morain C2,Tanner W A1,Keane F B V1

Affiliation:

1. Department of Clinical Surgery, The Meath and Adelaide Hospitals and Trinity College, Dublin

2. Department of Gastroenterology, The Meath and Adelaide Hospitals and Trinity College, Dublin

Abstract

Abstract Extracorporeal shock wave lithotripsy (ESWL) is successful in fragmenting gallstones, but <28 per cent of patients with gallstone disease fulfil the conventional criteria for treatment. However, no data exist to substantiate these selection criteria. In this study, the selection criteria were broadened to include patients with radiolucent stones of any size and number, and radio-opaque stones <3 cm in diameter. To date, 108 symptomatic patients with gallstones have received treatment. All patients received up to six outpatient sessions of ESWL (6000 shock waves per session) without sedation or analgesia. The dissolution therapy consisted of combined bile salt and terpene administration. The clearance rates were 9 per cent within 2 months, 21 per cent at 2-4 months, 38 per cent at 4-8 months, 60 per cent at 8-12 months, and 78 per cent at 12-18 months. Of patients with a successful outcome only 19 (18 per cent) would have satisfied traditional selection criteria. There have been no significant complications except in one patient who developed mild acute pancreatitis, which settled on conservative treatment, and two patients who developed acute cholecystitis. This study would suggest that the previously accepted selection criteria underestimate the number of patients suitable for gallstone ESWL and dissolution therapy.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference21 articles.

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2. Shock wave lithotripsy of gallstones: the first 175 patients;Sackman;N Engl J Med,1988

3. Extension of selection criteria for extracorporeal shock wave lithotripsy for gallstones;Darzi;Br Med J,1989

4. Gallstone disappearance after extracorporeal lithotripsy and oral bile acid dissolution;Ponchon;Gastroenterology,1989

5. Ursodeoxycholic acid for adjuvant therapy with extracorporeal shock wave lithotripsy of gallstones;Fromm;J Clin Gastroenterol,1988

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