The cystic duct and gallbladder were ablated in eight patients with acute gallbladder disease who had been treated with minicholecystostomy instead of cholecystectomy because of multiple risk factors. First, endoluminal transcatheter radio-frequency electrocoagulation of the cystic duct was performed under fluoroscopic control, which resulted in complete occlusion in all eight patients. Next, the mucosa of the isolated gallbladder was sclerosed with 95% ethanol and 3% sodium tetradecyl sulfate in one to four sessions; no analgesics were required. The gallbladder volumes of all patients, estimated by means of ultrasound, were 1.5-22 cm3 (average, less than 10 cm3) after a mean follow-up period of 5 months. One patient died of a cerebrovascular accident 15 months after sclerotherapy. In all surviving patients, the gallbladder fistulas are dry and obliterated. These early clinical data indicate that electrocoagulation permits reliable, safe obliteration of the human cystic duct. The authors believe that sclerotherapy of the isolated gallbladder is feasible without toxic effects but that their treatment needs adjustment to achieve complete ablation of the gallbladder mucosa in a shorter period and in all patients.

One hundred six patients underwent extracorporeal shock wave lithotripsy for cholelithiasis. Of these, 28 patients underwent cholangiographically guided lithotripsy for bile duct stones to assist nonoperative stone removal by endoscopic or radiologic intervention. Fragmentation occurred in 20 of 28 cases (71%) with an average of two lithotripsy sessions. Hemobilia was observed in four patients (14%) for a 24-hour period. Seventy-eight of the 106 were outpatients with symptomatic cholecystolithiasis with one to five calculi who underwent cholecystographic or ultrasound-(US) guided shock wave lithotripsy as definitive therapy. US examination showed stone fragmentation in 86% of cases. With an average of 1.6 treatment sessions and 4,750 shocks, fragments were 4 mm or smaller in 46% of patients. Nine percent of patients had no fragments after an average of 10 weeks, but long-term follow-up is not yet available. Two patients developed acute pancreatitis attributable to fragment passage and one patient acute cholecystitis, likely due to cystic duct obstruction by a fragment.

Gas was detected in the heart during some ILP exposures. Patients with a probe-patent foramen ovale (24% prevalence) could be at risk for paradoxic air embolus during ILP.

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Routine pre- and postlithotripsy chest radiographs are usually obtained on patients undergoing biliary extracorporeal shock-wave lithotripsy. To evaluate the need for this procedure, we reviewed posteroanterior and lateral chest radiographs obtained before and after 107 lithotripsy sessions in 75 patients. In each case, posteroanterior and lateral chest radiographs were obtained as a routine baseline (not to detect incidental abnormalities) before the patient was scheduled for lithotripsy. Posteroanterior and lateral chest radiographs were obtained routinely after each lithotripsy session. Seventy-five patients had 107 lithotripsy sessions on a second-generation lithotripter. Sixty had gallbladder stones, five had cystic duct stones, and 10 had common duct stones. All chest radiographs were reviewed by a chest radiologist. No pulmonary or pleural changes occurred after lithotripsy. We conclude that routine pre- and postlithotripsy chest radiographs are not warranted in patients undergoing biliary lithotripsy.