title: Intensified ESWL of gallstones: dissociation of pulverisation, pain relief and stone-clearance.
abstract: OBJECTIVE
  Recently, intensified shock wave lithotripsy for gallstone pulverisation and subsequent clearance without bile salt medication has been advocated. We report our first 44 patients treated by this regime: Patients with intact gallbladder function and symptomatic gallstones of any size, number and composition.
  
  
  METHODS
  Forty-four consecutive patients who received intensified shock wave lithotripsy for gallstone pulverisation and clearance were included in this study. The patients all had intact gallbladder function and presented with symptomatic gallstones of any size, number and composition.
  
  
  RESULTS
  Pulverisation was achieved in 75% of all cases (12 months), but only 34% were stone free. The proportion of patients with stone pulverisation compared to subsequent complete clearance was 93% versus 60% in small (</ = 20mm) solitary stones and 67% versus 15% in two or more stones. The pain intensity was markedly reduced within the first month of treatment, irrespective of complete pulverisation or definite stone clearance.
  
  
  CONCLUSIONS
  The approach of stone pulverisation by multiple shockwave treatments is effective in solitary stones but does not achieve adequate stone clearance in multiple gallstones. Despite the low stone clearance rates in multiple stones, intensified ESWL used alone may be effective for these patients, if they are not eligible for surgery and the purpose of treatment is pain relief.
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Brand
authors.forename: J
authors.initials: J
authors.lastname: Groth
authors.forename: L
authors.initials: L
authors.lastname: Lerche
authors.forename: E F
authors.initials: EF
authors.lastname: Stange
mesh_terms: D002769:Cholelithiasis / Q000150:complications / Q000628:therapy*; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000628:therapy; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology