title: Long-term evaluation of extracorporeal shock-wave lithotripsy for cholesterol gallstones.
abstract: BACKGROUND
  Extracorporeal shock-wave lithotripsy (ESWL) is a treatment that preserves the gallbladder. Problems after ESWL treatment include stone recurrence and the development of biliary symptoms.
  
  
  METHODS
  Two hundred and sixty-two patients with cholesterol-type gallstones, the best indication for ESWL treatment, and 42 control patients with cholesterol-type gallstones who received no treatment entered this study. We evaluated the factors associated with recurrence of gallstones after stone clearance and the development of biliary symptoms after ESWL treatment.
  
  
  RESULTS
  The 3-, 5- and 7-year cumulative probabilities of gallstone recurrence were 20.6, 27.1 and 33.1%, respectively, with the recurrence probability significantly lower in patients with good gallbladder contractility. In patients with recurrence, ursodeoxycholic acid (UDCA) treatment was effective. In 69 patients with residual gallstones, the 3-, 5- and 7-year cumulative risks of biliary symptoms were 17.3, 24.9 and 30.5%, respectively. With residual gallstones, the risk of biliary symptoms developing was significantly lower in patients with a < or = 3 mm fragment size at the end of ESWL treatment and in those treated consistently with UDCA for 6 months or more after treatment with ESWL. The risk of biliary symptoms was significantly lower in ESWL-treated patients with residual stones who had a < or = 3 mm fragment size after treatment compared to those of control patients.
  
  
  CONCLUSIONS
  Ursodeoxycholic acid was effective in clearing stones in patients with gallstone recurrence. In patients with residual stones, the fragmentation of stones to < or = 3 mm and UDCA administration effectively reduced the risk of subsequent biliary symptoms.
authors.affiliation: First Department of Medicine, Chiba University School of Medicine, Chiba-shi, Japan. tsumi-rei-cib@umin.ac.jp
authors.forename: R
authors.initials: R
authors.lastname: Tsumita
authors.forename: N
authors.initials: N
authors.lastname: Sugiura
authors.forename: A
authors.initials: A
authors.lastname: Abe
authors.forename: M
authors.initials: M
authors.lastname: Ebara
authors.forename: H
authors.initials: H
authors.lastname: Saisho
authors.forename: Y
authors.initials: Y
authors.lastname: Tsuchiya
mesh_terms: D016022:Case-Control Studies; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002769:Cholelithiasis / Q000737:chemistry / Q000628:therapy*; D002784:Cholesterol; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D002784:Cholesterol