[Results of 4 years of gallstone lithotripsy].
OBJECTIVE
Determination of the efficacy of extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones and adjuvant treatment with oral bile acids.


METHODS
Department of Surgery, University Hospital Dijkzigt, Rotterdam, the Netherlands.


METHODS
Descriptive clinical research.


METHODS
In 4 years, 133 patients (34 males and 99 females, mean age 49 years (range 24-81)) underwent 299 ESWL sessions, on an outpatient basis except for the first 16. All patients received adjuvant oral bile acid therapy (7-8 mg/kg body weight urso- and chenodeoxycholic acid, starting one day after ESWL). The number of ESWL sessions was 2.5 (mean; range: 1-7) with 2817 shock waves (75-4000), a session duration of 62 min (35-210). 73.7% of the patients (n = 98) required intravenous analgesic sedation.


RESULTS
At a mean follow-up of 13.8 months (1-45), 27.6% of the patients were free of stones. At 1 year after the first ESWL session, 51.0% of the patients with a solitary stone and 8.3% of the patients with 2-10 stones were free of stones (p < 0.0001). Of the 43 patients who had become free of stones 6 developed recurrent stones (14.0%). Fifty-seven patients (42.9%) suffered from colic, 9 (6.8%) from obstruction of the common bile duct, including 4 who developed pancreatitis. Two patients had transient haematuria and one acute cholecystitis; 15 (11.3%) suffered from an oral bile acid-related diarrhoea, which could easily be resolved by lowering the dose of chenodeoxycholic acid. 30 patients (22.6%) underwent cholecystectomy.


CONCLUSIONS
Our results reconfirm that ESWL is safe and moderately effective in selected patients. Nowadays most patients choose laparoscopic cholecystectomy, which implies that ESWL will be confined to patients with an increased operative risk and to those who refuse surgery. ESWL should be limited to patients with solitary stones.
Plaisier
P W
PW
Afd. Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt.
van der Hul
R L
RL
den Toom
R
R
Nijs
H G
HG
Terpstra
O T
OT
Bruining
H A
HA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002635:Chenodeoxycholic Acid / Q000627:therapeutic use; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000601:surgery / Q000628:therapy*; D002779:Cholestasis / Q000209:etiology; D003085:Colic / Q000209:etiology; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid
De resultaten van 4 jaar galsteenvergruizing.