The role of extracorporeal shock-wave lithotripsy in the treatment of symptomatic cholelithiasis.
OBJECTIVE
To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and adjuvant bile-salt therapy for the treatment of symptomatic cholelithiasis.


METHODS
A prospective case study. Follow-up ranged from 3 to 54 months.


METHODS
A university teaching hospital.


METHODS
Two hundred and twenty-three patients with symptomatic cholelithiasis, a gallbladder that opacified at oral cholecystography and three or fewer radiolucent stones with a maximum total dimension of 3 cm. Of these patients, 197 were given bile salts (ursodeoxycholic acid or chenodeoxycholic acid, 8 to 10 mg/kg daily) and underwent ESWL. Twenty-eight were excluded because of noncompliance with the protocol or treatment failure before termination of the ESWL procedure.


METHODS
ESWL with a piezoelectric lithotripter.


METHODS
The success rate of the intervention, the causes of failure, associated complications and the recurrence rate of cholelithiasis.


RESULTS
Of the 197 patients who underwent ESWL, 85 (43%) were free of stones after treatment. Treatment failure was caused by the following: unsatisfactory fragmentation (9%), increase in fragment size during bile-salt therapy (8%), severe diarrhea due to bile salts (3%), nonvisualization of fragments after the first ESWL (3%), acute cholecystitis (2%), persistence of small fragments at the end of the treatment protocol (2%) and acute pancreatitis (0.5%). Complications included biliary colic (21%), diarrhea (15%), acute cholecystitis (2.5%), acute pancreatitis (2%), macroscopic hematuria (2%), perirenal hematoma (0.5%) and vagal shock (0.5%). The recurrence rate was 18%. Causes of noncompliance with treatment (26%) were the length of treatment, the occurrence of biliary colic during this period and the high cost of bile salts.


CONCLUSIONS
ESWL with bile salts as treatment for symptomatic cholelithiasis is not recommended for routine use.
Dion
Y M
YM
Department of Surgery, Hôpital St-François d'Assise, Québec.
Morin
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001647:Bile Acids and Salts / Q000627:therapeutic use*; D002769:Cholelithiasis / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D016312:Treatment Refusal
D001647:Bile Acids and Salts