Shock-Wave Lithotripsy of Gallbladder Stones

Costs and Effectiveness of Extracorporeal Gallbladder Stone Shock Wave Lithotripsy Versus Laparoscopic Cholecystectomy: A Randomized Clinical Trial

“…Since the first cholecystectomy was performed by Carl Langenbuch in 1882 (Il), many non-surgical treatmenls for the management of cholelithiasis had been developed, and there has been a recent resurgence in these with the advent of successful ESWL (12) and LC (6,7). In view of the benign course of most gallstones (2,3), and the safety and success of cholecystectomy (13), any new treatment modality must be rigorously assessed to evaluate ils comparative efficacy, effectiveness, safety, and eventually cost-effectiveness.…”

“…Animal safety studies (119,122,123), and human pathological data (124) have confirmed that trifle or no tissue damage occurs, as long as thc shock wave path avoids the lung bases (125). The eligibility criteria adopted by most c1inical studics published to date followed the initial Münich recommendations (126), which restrict the technique to patients with functioning gallbladders, with not more than three stones. a maximum stone diameter of 30 mm or less and with no visible X-ray calcifications of the stone.…”

“…Satisfactory fragmentation (defined by the persistence of fragments of no more than 5 mm (5)) seems to approximate 40-60%, although heterogeneity in reporting makes conclusions somewhat uncertain (5,126,128,(135)(136)(137)(138)(139)(140)(141)(142)(143)(144)(145)(146)(147)(148)(149)(150). Electrohydraulic generators have on average required fewer sessions than the other two generator types to achieve this endpoint (5).…”

“…Electrohydraulic generators have on average required fewer sessions than the other two generator types to achieve this endpoint (5). It would appear that the shock waves themselves are safe though they cause reversible enzymatie rises (126,(135)(136)(137)(138)(139)(140)(141)(142)(143)(144)(145)(146)(147)(148)(149)(150) Although in vitro data suggest the basis for a possible expansion of selection criteria on the basis of CT scan appearance (116), small, solitary, uncalcified stones are the most likely to fragment satisfactorily, and will do so 70% of the time (5). The resulting fragments are then treated by oral bile acids, which have been shown to accelerate the dissolution rate (151).…”

The influence of high-energy shock waves on the development of metastases

“…Several other applications of HESW have been reported, such as disintegration of salivary gland stones and gall blad der stones, treatment of fractures and tumor treatment (Cornel et al 1994a;Iro et al 1989;Sackman 1988;Sauerbruch et al 1986;Valchanou and Miehailov 1991 ). in particular, since HESW can be focused into a small area of interest within the body, the efficacy of HESW as a new experimental noninvasive antitumor therapy has been extensively investigated.…”