Fragmentation of Gallstones by Extracorporeal Shock Waves

Abstract

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.

Gallstone disease: From genes to evidence-based therapy

“…UDCA has also been used successfully in patients with microlithiasis and recurrent ''idiopathic" pancreatitis [88]. Due to the unsatisfactory long-term results with recurrence rates >40% after 5 years [113], extracorporeal shock-wave lithotripsy (ESWL) of gallbladder stones, which was pioneered in the 1980s at the University of Munich [114], has been replaced by laparoscopic cholecystectomy.…”

Reactive Oxygen Species and the Hypomotility of the Gall Bladder as Targets for the Treatment of Gallstones with Melatonin: A Review

“…Both drugs cause mild diarrhea, and chenodiol is associated with a temporary rise in the levels of blood cholesterol and the liver enzyme transaminase [4]. Extracorporeal shockwave lithotripsy plus oral bile acids for symptomatic gallstones was introduced two decades ago [93]. However, subsequent studies proved the recurrence of gallstones in 30-50% of cases 5 years after bile salt therapy or lithotripsy [94,95].…”

Symptomatic gallbladder stones

“…Patients were accepted for ESWL according to the Munich criteria [13,17] (symptomatic gallbladder stones, no bile duct stones, no pancreatitis, no acute cholecystitis, one radiolucent stone with a maximal diameter of 30 mm or up to three stones with the same maximal stone volume in a gallbladder opacifying on oral cholecystogram, no coagulation disorder or peptic ulcer; rim calcification of stone was a relative contraindication). Of the patients 60% had a solitary stone and 40% had two or three stones.…”

“…However, conventional cholecystectomy carries a small risk of morbidity and mortality. Therefore, extracorporeal shock-wave lithotripsy (ESWL) with adjuvant bile acid therapy to dissolve residual fragments has recently been proposed as an alternative treatment in selected patients [17]. Initial results for ESWL were cause for optimism, with more than 90% of patients stone-free after a follow-up of 12-18 months [13].…”