title: Absence of apolipoprotein E4 genotype, good gallbladder motility and presence of solitary stones delay rather than prevent gallstone recurrence after extracorporeal shock wave lithotripsy.
abstract: OBJECTIVE
  Extracorporeal shock wave lithotripsy (ESWL) with adjuvant bile salt dissolution therapy may be successful in selected gallstone patients, but the considerable risk of recurrence is a major drawback. Apolipoprotein E4 genotype and impaired gallbladder motility have been identified as major risk factors for recurrence during short-term follow up. We have now examined their relevance during long-term follow up.
  
  
  METHODS
  Eighty-four cholesterol gallstone patients (55 solitary and 29 multiple (two to ten) stones) were followed prospectively up to 10 years after complete stone disappearance. Various potential risk factors for recurrence were evaluated.
  
  
  RESULTS
  Gallstone recurrence was found in up to 80% of patients at 10 years follow-up. Absence of the apolipoprotein epsilon4 allele, initial solitary stones, good gallbladder emptying (i.e. minimal postprandial volume < or = 6 ml) and 2-year postdissolution ursodeoxycholic acid prophylaxis (in ten patients) all delayed but did not prevent recurrence. In contrast, regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was identified as an independent protective factor, with greatly decreased recurrence (at 10 years: 58 vs 93% in non-NSAID users, P = 0.03).
  
  
  CONCLUSIONS
  Non-apolipoprotein E4 genotype, presence of solitary stones and good gallbladder emptying delay rather than prevent recurrence after initially successful ESWL. Regular use of NSAIDs may prevent recurrence.
authors.affiliation: Department of Gastroenterology, University Medical Center Utrecht, The Netherlands.
authors.forename: N G
authors.initials: NG
authors.lastname: Venneman
authors.forename: G P
authors.initials: GP
authors.lastname: vanBerge-Henegouwen
authors.forename: P
authors.initials: P
authors.lastname: Portincasa
authors.forename: M F
authors.initials: MF
authors.lastname: Stolk
authors.forename: A
authors.initials: A
authors.lastname: Vos
authors.forename: P W
authors.initials: PW
authors.lastname: Plaisier
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics*; D002769:Cholelithiasis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000503:physiopathology*; D005838:Genotype; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D053327:Apolipoprotein E4; D001057:Apolipoproteins E