Safety and efficacy of repeated shockwave lithotripsy of gallstones with and without adjuvant bile acid therapy.
OBJECTIVE
The value of adjuvant bile acid dissolution therapy after extracorporeal shockwave lithotripsy (ESWL) of gallbladder stones is under debate. A double-blind, randomized, multicenter trial was conducted to determine the safety and efficacy of repeated ESWL with and without adjuvant bile acid therapy.


METHODS
At five centers, 153 patients with gallstones and good gallbladder emptying were randomized to undergo up to six high-energy lithotripsy sessions combined with ursodeoxycholic acid (UDCA, 750 mg/day; n = 77) or placebo (n = 76).


RESULTS
Six months after the initial treatment, 77% of patients with small single stones (< or = 20 mm in diameter), 60% with large single stones (> 20 mm in diameter), and 41% with multiple stones were free of stones. Administration of UDCA had no effect on stone disappearance in the whole study group but tended to improve stone disappearance rates in patients with large single stones and tended to decrease biliary adverse effects in patients with multiple stones.


CONCLUSIONS
Repeated high-energy ESWL without adjuvant bile acid therapy represents a safe and effective treatment in patients with small single stones and good gallbladder emptying. In patients with large single stones and multiple stones, adjuvant bile acid therapy may be beneficial.
Sauter
G
G
Department of Medicine of the Klinikum Grosshadern, University of Munich, Germany. sauter@med2.med.uni-muenchen.de
Kullak-Ublick
G A
GA
Schumacher
R
R
Janssen
J
J
Greiner
L
L
Brand
B
B
Stange
E F
EF
Wengler
K
K
Lochs
H
H
Freytag
A
A
Wissing
A
A
Holl
J
J
Sackmann
M
M
Paumgartner
G
G
D000277:Adjuvants, Pharmaceutic / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000277:Adjuvants, Pharmaceutic; D014580:Ursodeoxycholic Acid