[Optimized extracorporeal shockwave lithotripsy of gallbladder calculi: a prospective randomized therapy comparison].
Is "pulverization" or "fragmentation" the best endpoint of extracorporeal shock wave application in ESWL of gallbladder stones? Has gallbladder motility a potential for the prevention of stone recurrence?


METHODS
Prospective, monocentric study with randomization between the conventional treatment strategy (endpoint of shock wave application: fragments < or = 4 mm, concomitant oral chemolitholysis) and an intensified treatment strategy (endpoint of shock wave application: Pulverization, no chemolitholysis). Prevention of stone recurrence: At least once per month for one hour after a meal standardized position (back position, lowered chest).


RESULTS
34 patients, age 46 +/- 14 years (27 women, seven men) were included (F-ESWL: n = 18; P-ESWL: n = 16). Gallbladder motility, number, size and CT-measured calcifications of stones were comparable for both groups. P-ESWL patients received more shock wave pulses than F-ESWL patients and more treatment sessions. P-ESWL resulted in a better fragmentation and pulverization of stones was reached significantly more often (p < 0.05). The time period for stone clearance was significantly depending on the fragmentation result (pulverization: 0.7 months vs. fragments < or = 4 mm: 6.6 months vs. fragments > or = 4 mm: 8.0 months; p < 0.01). The stone free rate after twelve months was 87.5% for P-ESWL and 72.2% for F-ESWL (n.s.) and correlated significantly with the fragmentation result (p < 0.01). Pain sensations during stone clearance were significantly reduced by P-ESWL. Stonefree patients were followed up for 30 +/- 13 months, the total recurrence rate was 7.1%.


CONCLUSIONS
Aiming for pulverization of gallbladder stones by means of intensified extracorporeal shock wave application is at least equal or in tendency superior compared to disintegration to fragements < or = 4 mm. Gallbladder motility might be useful to prevent gallstone recurrence after successful ESWL.
Rabenstein
T
T
Medizinische Klinik I, Universität Erlangen-Nürnberg.
Benninger
J
J
Farnbacher
M
M
May
A
A
Ell
C
C
Katalinic
A
A
Hahn
E G
EG
Schneider
H T
HT
D000328:Adult; D000368:Aged; D002635:Chenodeoxycholic Acid / Q000008:administration & dosage; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D016473:Gallbladder Emptying / Q000502:physiology; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011292:Premedication; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
D004338:Drug Combinations; D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid