Gallbladder stone fragments in feces after biliary extracorporeal shock-wave lithotripsy

Greiner, Lucas; Münks, Claudia; W, Heil; Jakobeit, Christian

doi:10.1016/0016-5085(90)91099-r

Cited by 59 publications

(16 citation statements)

References 15 publications

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“…1,2 Although bile salt dissolution therapy plays a major role during gallstone clearance, 28 our findings stress the importance of effective gallbladder motility as an additional factor. 15,29 Indeed, impaired gallbladder motility is common in gallstone patients, 24,30 as also shown in this study, and may delay the expulsion of residual fragments. ESWL per se does not alter gallbladder motility, 31 but adjuvant bile salt therapy might do so.…”

Section: Discussionsupporting

confidence: 58%

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Portincasa¹,

Erpecum²,

Meeberg³

et al. 1996

Hepatology

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as well as a high risk of recurrence after ESWL. This Extracorporeal shock-wave lithotripsy (ESWL) is an finding points to a possible role for genetic factors in effective treatment in selected gallstone patients, but the pathogenesis of cholesterol gallstones. Effective gallstone recurrence is a major drawback. Factors potenbladder emptying is important for speed of clearance tially influencing gallstone clearance and recurrence and prevention of recurrence. Patients with initial soliwere studied in 84 patients in whom stone dissolution tary stones have a decreased early-but not long-term was diagnosed after ESWL plus bile salt therapy for inigallstone recurrence rate. (HEPATOLOGY 1996;24:580-tial solitary (n ! 55) or multiple (n ! 29) radiolucent 587.) stones. Apolipoprotein E (apoE) genotyping and gallbladder motility (sonography) were studied in a representative subgroup of patients (n ! 50). The median follow-up after ESWL was 36 months (range, 4.5-67 months).Extracorporeal shock-wave lithotripsy (ESWL) with adjuGallstone clearance was achieved after 8.7 months vant bile salt therapy to dissolve fragments is effective in (range, 0.2-30 months). Independent factors significantly selected patients with gallbladder stones. In the case of solienhancing gallstone clearance were the presence of E4 tary radiolucent gallstones with a diameter°20 mm, comallele; small initial gallstone size and number; effective-plete clearance can be expected in 70% to 80% of patients ness of fragmentation; and good gallbladder emptying after a year of treatment.1,2 Results, however, are consider-(P ! .002). Gallstone recurrence was seen in 30 patients ably less favorable for patients with larger or multiple gallafter 18.6 months (range, 1.0-50 months). Cumulative stones. A major drawback of nonsurgical therapy is the risk gallstone recurrence rate (life-table analysis) was 15% of gallstone recurrence after initially successful treatment. within 1 year, increasing to 60% within 5.5 years. Al-Previous studies on patients treated with oral bile salts sugthough the probability of gallstone recurrence tended gested a 50% recurrence rate at a 5-year follow-up with low or to be smaller in patients with initial solitary stones than no recurrence thereafter. 3,4 The fact that gallstone recurrence in those with multiple stones during early follow-up, dif-occurs in only one half of the patients suggests the existence ferences disappeared after long-term follow-up. Effec-of two subgroups of patients, one with a permanent and the tive gallbladder emptying (residual volume Ù6 mL) and other with a transient defect (e.g., pregnancy, oral contracepapolipoprotein E4 (apoE4) independently influenced tives, postmenopausal estrogens, weight loss in obese pagallstone recurrence. Recurrence rate was higher (log tients, and major abdominal surgery: all considered risk facrank test, P ! .037) in those patients who were homozy-tors for gallstone development). In particular, patients with gous and heterozygous for the E4 allele compared with initially multip...

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Section: Discussionsupporting

confidence: 58%

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Portincasa¹,

Erpecum²,

Meeberg³

et al. 1996

Hepatology

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“…Other techniques using piezoceramic (152, 153) and eledromagnetic (154, 155) principles have been developed for cholecystolithotripsy. The current goals of ESWL are to facilitate stone dissolution by bile acids, especially in stones larger than 10 mm, and to allow spontaneous passage of fragments into the intestine (151,156,157).To assess the clinical effectiveness of ESWL, we have mainly used the results of the Munich group (158,159). Agam, this is an example of selecting the best results from a single center in which therapy was given by a small group of very experienced individuals whose interest is focused in this area.…”

mentioning

confidence: 99%

Cholecystolithiasis: Lithotherapy for the 1990s

Strasberg

Clavien

1992

Hepatology

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Cholelithiasis afTects from 10% to 15% of the adult population in industrialized Western countries, with higher prevalence in women, in women with high parity, in the obese, in patients with hypertriglyceridemia and in older patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In the United States, it has been estimated that 20 to 25 million people have gallstones, and more than 500,000 cholecystectomies are performed annually. Cholecystectomy is the most frequently performed surgical procedure, after cesarean section in this country (141, with an annual cost estimated at $4 to 5 billion. About a quarter of all women will experience cholelithiasis by age 60 in industrialized Western societies; the prevalence in men is about half that of womenThe fist effective treatment for cholelithiasis was cholecystostomy (15, 161, a procedure that was abandoned in the early decades of this century because of the high incidence of stone recurrence. Open cholecystectomy (OC) was introduced more than 100 yr ago (17) and remained the sole effective treatment of this disease for about 90 yr. During this period, the only decision that was required for a patient with cholelithiasis was whether treatment was indicated or not. In the last two decades several new treatments, such as oral bile acid therapy (BAT), extracorporeal shock wave lithotripsy (ESWL) and, more recently, laparoscopic cholecystectomy (LC) have become available. Therefore, it is now not only necessary for physicians to decide whether to treat gallstones but also to recommend the most suitable type of treatment. The purpose of this work is to present an evaluation of the newer therapies (mainly in comparison with OC) including the basis for selection of therapy in individual patients. CLINICAL STAGES OF CHOLELITHIASISCholelithiasis has three clinical stages: the asymptomatic and symptomatic stages and the stage of complications. Complicated forms of cholecystolithiasis include acute cholecystitis and its complications, choledocholithiasis and its complications, gallstone ileus and gallbladder cancer. These complications are much 31/1/40081 more serious than symptomatic cholelithiasis and usually require prompt and invasive treatment. Treatment of the complicated forms of cholelithiasis will not be considered in this work, but it should be noted that it is the avoidance of such complications that constitutes an important rationale for therapy in the symptomatic stage or even under special circumstances in the asymptomatic stage (18)(19)(20)(21)(22)(23)(24)(25).Of critical importance in making recommendations about treatment is knowledge of the natural history of cholelithiasis (i.e., the rate of conversion from the asymptomatic stage to the other stages). Such information is necessary to weigh the risk of expectant management against the hazards of treatment. Historical series on the natural history of gallstones have yielded controversial results, mainly because of the inclusion of many patients with biliary symptoms at the start of the study; this distorts the resu...

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“…After lithotripsy the fragments have to be cleared from the gall bladder. Some fragments up to 8 mm in diameter pass spontaneously through the cystic duct and can be found in feces afterwards [7], The spontaneous clearance of the gallbladder, however, is in most cases not sufficient. Remaining fragments have to be dissolved, e.g.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Lithotripsy of Gallstones in Different Biles and Water in vitro

Nitsche¹,

Amelsberg²,

Berg

et al. 1994

Digestion

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Twenty-four gallstones were fragmented by extracorporeal shock wave lithotripsy (ESWL) to compare the influence of three different biles (bovine bile, human bile, synthetic bile) and water on the rapidity of fragmentation. Four groups of comparable stones were used for lithotripsy in vitro. The stones were collected from 6 patients, four nearly identical ‘sister’ stones from each patient. The number of shock waves required for adequate fragmentation (fragments ≤ 4 mm) was measured for comparison. Overall highly significant differences were found for the four different ‘biles’ with regard to the number of shock waves required for adequate fragmentation. Using synthetic bile, which was artificially composed according to a textbook on hepatology, significantly more shock waves were necessary for fragmentation compared to the use of water, bovine bile or human bile. On the other hand, no significant difference between water and human bile could be registered. We conclude that the number of shock waves required for adequate lithotripsy is influenced by the composition of bile in which the stone is fragmented. Possibly results of ESWL can be improved by manipulation of the bile.

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Gallbladder stone fragments in feces after biliary extracorporeal shock-wave lithotripsy

Cited by 59 publications

References 15 publications

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Cholecystolithiasis: Lithotherapy for the 1990s

Extracorporeal Shock Wave Lithotripsy of Gallstones in Different Biles and Water in vitro

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