Significance of computed tomography for shock-wave therapy of radiolucent gallbladder stones

Ell, Christian; Schneider, H. T.; Benninger, J.; Theobaldy, S; Friedel, N.; Rödl, W; Wirtz, Peter; Hahn, Eckhart G.

doi:10.1016/0016-5085(91)90095-3

Cited by 31 publications

(10 citation statements)

References 17 publications

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“…Previous attempts to correlate CT findings with gallstone fragmentation have yielded conflicting results [4,7]. We did not find any correlation of fragmentation with CT density.…”

Section: Discussioncontrasting

confidence: 78%

Brittleness of gallstones to lithotripsy: effect of physicochemical and ultrastructural characteristics

Choudhuri

Agarwal

Phadke

et al. 1994

Eur J Clin Investigation

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Why some gallstones do not fragment easily to lithotripsy is unclear. The aim of the present study was to determine gallstone factors associated with resistance to fragmentation. Seventy-six cholesterol rich gallstones were subjected to physical evaluation, in vitro computed tomography, chemical analysis by infra red spectroscopy, and ultrastructural studies (of 26 matched stones) by scanning electron microscopy and energy dispersive X-ray microanalysis. In vitro lithotripsy was performed with the Siemens Lithostar Plus machine at a constant energy level. Of 76 stones, 33 required > 1000 shocks for effective fragmentation (largest diameter < or = 5 mm); they had significantly higher maximum diameter (P < 0.001), volume (P < 0.001), weight (P < 0.001) and lower stone density distribution (SDD) index (P < 0.05) and lower calcium bilirubinate content (P < 0.001) than those requiring < or = 1000 shocks. Large (> 15 mm; P < 0.05), round stones (P < 0.02) and gallstones with SDD index of < 50 HU (P < 0.02) and gallstones with SDD index of < 50 HU (P < 0.05) were more difficult to fragment. Clinical application of these parameters may help in better selection of patients for this non-surgical mode of therapy for gallstones.

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“…Previous attempts to correlate CT findings with gallstone fragmentation have yielded conflicting results [4,7]. We did not find any correlation of fragmentation with CT density.…”

Section: Discussioncontrasting

confidence: 78%

Brittleness of gallstones to lithotripsy: effect of physicochemical and ultrastructural characteristics

Choudhuri

Agarwal

Phadke

et al. 1994

Eur J Clin Investigation

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“…There have been many reports of the effectiveness of ESWL from Japan and other countries [7,21,22,[77][78][79][80][81][82], including long-term outcomes over 5-10 years of followup [83][84][85][86]. The elimination rate 1 year after ESWL treatment of patients with single gallstones, gallstones smaller than 20 mm in diameter, and noncalcified pure cholesterol gallstones (characteristic ultrasound image, radiolucency, CT value of less than 50 HU) ranged from 63% to 90% [7,21,22,[77][78][79][80][81][82][83][84].…”

Section: Commentarymentioning

confidence: 99%

“…The elimination rate 1 year after ESWL treatment of patients with single gallstones, gallstones smaller than 20 mm in diameter, and noncalcified pure cholesterol gallstones (characteristic ultrasound image, radiolucency, CT value of less than 50 HU) ranged from 63% to 90% [7,21,22,[77][78][79][80][81][82][83][84]. For calcified cholesterol gallstones, which are relatively common in Japan, the elimination rate 1 year after ESWL was reported to be 60% [87].…”

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

209

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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“…The presence of significant stone calcification probably precluded complete dissolution by the ursodeoxycholic acid-chenodeoxycholic 41 acid combination. Possibly, examination of duodenal bile for the presence of cholesterol monohydrate crystals [4] or computed tomographic analysis of gallbladder stones [3] may be valuable in patient selection for ESWL. However, these selection procedures will further increase costs and will further reduce the number of patients eligible for ESWL.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic gallbladder stones

Stolk²,

Obertop

et al. 1995

Surg Endosc

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In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy (LC). Data were analyzed from 55 patients who were treated by ESWL, 45 patients who had CC, and 47 patients who had LC. The study was performed by analysis of patients charts and a written questionnaire. After ESWL 35% of the patients were free of stones, 23% had fragments < or = 5 mm, and 42% had fragments > 5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ESWL, 11% after CC, and 14% after LC (P < 0.001). New complaints arose in 12% after ESWL, 11% after CC, and in 5% after LC (P = NS). Patient appreciation score was highest for LC and lowest for ESWL. Mean hospital stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Overall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,117 for LC. This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with symptomatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.

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Significance of computed tomography for shock-wave therapy of radiolucent gallbladder stones

Cited by 31 publications

References 17 publications

Brittleness of gallstones to lithotripsy: effect of physicochemical and ultrastructural characteristics

Brittleness of gallstones to lithotripsy: effect of physicochemical and ultrastructural characteristics

Evidence-based clinical practice guidelines for cholelithiasis 2016

Symptomatic gallbladder stones

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