This report describes a newly developed catheter system with the aid of which the cystic duct and gallbladder can be reliably catheterized, retrograde, via an endoscope. In 8 out of 10 autopsy preparations, transpapillary gallbladder catheterization was successfully achieved, with an average fluoroscopic duration of 12 minutes (range: 4-20 minutes). Neither macroscopic nor microscopic traumatization of the gallbladder was observed. The procedure described in this paper opens up a diagnostic and therapeutic approach to the gallbladder.
A new extracorporeal piezoelectric lithotripter was tested for its gallstone disintegration capability. A total of 177 surgically removed gallbladder stones were submitted to piezoelectric shock-wave treatment. Prior to shock-wave application, the diameter, weight, and volume of all the stones and CT density and MR signal intensity of selected stones were determined. After shock-wave application, the chemical composition of the stones was investigated by x-ray diffractometry and/or infrared spectrometry. All the stones (maximum diameter 6-30 mm) were successfully fragmented; calculi with a maximum diameter of 17 mm, a maximum weight of 1800 mg, and a maximum volume of 2 cc were regularly disintegrated into fragments less than or equal to 4 mm. The number of shock waves required correlated most closely with volume (r = 0.82, P less than 0.001), weight (r = 0.81, P less than 0.001) and, to a somewhat lesser degree, diameter (r = 0.62, P less than 0.001). No correlation was found between the chemical composition, CT density, or MR intensity of the calculi and the number of pulses needed for fragmentation.
SUMMARYThe tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave application to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative.Non-surgical procedures for the treatment of cholecystolithiasis must be measured against the effectiveness of cholecystectomy and its low morbidity (7%) and mortality (0.4%) rates.' In contrast with oral chemolitholysis alone, extracorporeal shockwave lithotripsy in combination with chemolitholytic post-treatment, appears to be a promising alternative to cholecystectomy in selected patients.2 Sauerbruch et al adapted a kidney stone lithotripter that worked on the basis of the high voltage spark gap discharge principle to the requirements of the biliary system, and reported a 78% stone free rate in patients with solitary stones (up to 20 mm) after four to eight months.3Using a new type of lithotripter that generates shockwaves using the piezoelectric principle, we have been able to show that gall stones can be disintegrated reliably and reproducibly.45 The
The first ultrasonographically controlled fragmentation of multiple pancreatic duct stones of up to 14 mm size by means of extracorporeal, piezoelectric shockwave lithotripsy is reported. On account of the ultrasound localization and continuous control during therapy a nasopancreatic tube for instillation of contrast medium and frequent x-ray checks were not necessary. The 48-year-old patient did not experience any pain during the four treatment sessions and during the follow-up period. No complications were noted.
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