Extracorporeal shock-wave lithotripsy of gallbladder stones: an alternative for the selected few.
OBJECTIVE
To define selection criteria for optimal outcome of ESWL with oral litholysis (ursodeoxycholic acid) for gallbladder stones.


METHODS
Prospective study.


METHODS
University hospital, Sweden.


METHODS
145 patients with symptomatic gallbladder stones occupying a maximum of half the fasting gallbladder volume and gallbladder opacification at oral cholecystography.


METHODS
Three-year stone clearance rates in relation to initial stone burden, occurrence of calcified stones, and degree of gallbladder opacification at cholecystography.


RESULTS
At all times clearance rates according to life table analysis were significantly higher for patients whose stone volume was < or = 4.2 ml (corresponding to one stone with a diameter of < or = 2.0 cm) (83% at 3 years) than for patients whose stone volume was > 4.2 ml (67% at 3 years), and patients with one stone had significantly higher clearance rates (88% at 3 years) than patients with multiple stones (58% at 3 years). Of all patients treated for gallbladder stones during one year, 25/194 (13%) had a stone volume of < or = 4.2 ml and 16/194 (8%) a solitary stone with volume < or = 4.2 ml. Neither the degree of gallbladder opacification nor the occurrence of calcified stones influenced clearance rates.


CONCLUSIONS
ESWL may be an alternative to surgery in the few patients whose stone volume is roughly 4 ml or less and preferably have only one stone. Gallbladder function and patency of the cystic duct are poorly evaluated by oral cholecystography.
Borch
K
K
Department of Surgery, University Hospital of Linköping, Sweden.
Jönsson
K A
KA
Lindström
E
E
Carlsson
P
P
Kullman
E
E
Ihse
I
I
Svanvik
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002769:Cholelithiasis / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid