Long-term gallbladder stone recurrence and risk factors after successful lithotripsy.
OBJECTIVE
The risk of recurrence has limited the acceptability of conservative therapies of gallbladder stones. The aim of the present study was to determine the rate of stone recurrence and its risk factors, after successful shock-wave lithotripsy.


METHODS
Prospective ultrasound follow-up at yearly intervals or whenever biliary pain was reported.


METHODS
One hundred and fifty-eight consecutive patients (single stone, n = 130; two or three stones, n = 28) were followed up to 70 months (median, 33 months) after stone disappearance and discontinuation of ursodeoxycholic acid.


RESULTS
Forty-three patients developed recurrent stones. By actuarial analysis, the recurrence rates (as a percent) at 1, 2, 3, 4 and 5 years were, respectively: 6+/-2, 14+/-3, 27+/-4, 35+/-5, and 44+/-6 (observed +/- SE). Cox's regression analysis identified high body mass indexes to be a risk factor (P = 0.02) for newly formed stones. Having had a single primary stone did not seem to be protective. Fourteen of the 43 patients (33%) had early symptoms of recurrence. Thirty-eight patients (89%) chose to undergo oral dissolution again, which was complemented by lithotripsy in eight patients (19%).


CONCLUSIONS
The 5-year gallbladder stone recurrence after lithotripsy and ursodeoxycholic acid is not substantially smaller than that reported by post-bile acid studies. Obesity is a risk factor for recurrent stones as it is for primary stones. Most patients with secondary stones choose to have conservative therapy again. Gallbladder stone recurrence still is one of the major drawbacks of these treatments and cost-effective strategies are needed to prevent it.
Carrilho-Ribeiro
L
L
Centre of Gastroenterology, University Hospital of Santa Maria, Lisbon, Portugal.
Pinto-Correia
A
A
Velosa
J
J
de Moura
M C
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid