Gallbladder emptying determines early gallstone clearance after shock-wave lithotripsy.
OBJECTIVE
Disappearance of gallbladder stones after shock-wave lithotripsy combined with bile acid therapy depends on mechanical evacuation and dissolution of fragments. Many patients with gallstones have impaired gallbladder emptying and may show delayed stone clearance after lithotripsy.


METHODS
The effect of gallbladder emptying on gallstone clearance after lithotripsy was prospectively studied in 57 patients with one radiolucent gallbladder stone < or = 20 mm. Gallbladder emptying was assessed sonographically before and after 2 weeks of ursodeoxycholic acid (UDCA) treatment.


RESULTS
UDCA increased gallbladder fasting and residual volume and decreased ejection rate but did not affect ejection fraction. Patients with an ejection fraction > 60% achieved complete gallstone clearance after lithotripsy in a higher percentage than patients with smaller ejection fractions (1 month, 31% vs. 7%, P = 0.022; 2 months, 55% vs. 18%, P = 0.003; 3 months, 66% vs. 29%, P = 0.005). Patients who became stone-free within 1 month showed larger ejection fractions than patients with retained fragments (67% +/- 4% vs. 56% +/- 3% before UDCA, P = 0.032; 65% +/- 4% vs. 53% +/- 3% with UDCA, P = 0.017). Further, ejection rate during UDCA therapy was larger in patients with complete gallstone disappearance within 1 month than in patients with delayed fragment clearance (1.57%/min +/- 0.36%/min vs. 0.76%/min +/- 0.09%/min; P = 0.002).


CONCLUSIONS
Gallbladder emptying is a major determinant of early gallstone clearance after lithotripsy.
Pauletzki
J
J
Department of Medicine II, Klinikum Grosshadem, University of Munich, Germany.
Sailer
C
C
Klüppelberg
U
U
von Ritter
C
C
Neubrand
M
M
Holl
J
J
Sauerbruch
T
T
Sackmann
M
M
Paumgartner
G
G
D000328:Adult; D016009:Chi-Square Distribution; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D016473:Gallbladder Emptying; D006801:Humans; D015993:Life Tables; D008096:Lithotripsy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D014580:Ursodeoxycholic Acid