Aggressive extracorporeal shock wave lithotripsy of gall bladder stones within wider treatment criteria: fragmentation rate and early results.

Abstract

Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9 5% of the patients had more than three stones. Stones were successfuliy disintegrated in 218 patients (fragmentation size <5 mm in 80%, <10 mm in 19%). Some 65% of patients required one treatment and the rest two or three. A mean (SD) of4100 (1800) (24) years were treated. The onset of symptoms of gall stones had occurred 5-5 (2 3) years previously. The mean (SD) size of the stones was 19 (6) mm. A total of 412 stones were found in these patients -124 had a solitary stone and 118 had between two and a maximum of five radiolucent stones.

Cholecystolithiasis: Lithotherapy for the 1990S

“…Agam, this is an example of selecting the best results from a single center in which therapy was given by a small group of very experienced individuals whose interest is focused in this area. Other results, particularly those from multicenter trials, are not as good in terms of cure or safety (91,153,155,(160)(161)(162). It seems to us that the results of the Munich group would be reproducible in other centers, given that their methods are followed by individuals with experience in ESWL.…”

“…Treatment of gallbladder stones with shock waves generated extracorporeally with an electrohydraulic method was introduced in the mid-1980s by the Munich group (151). Other techniques using piezoceramic (152,153) and eledromagnetic (154,155) principles have been developed for cholecystolithotripsy. The current goals of ESWL are to facilitate stone dissolution by bile acids, especially in stones larger than 10 mm, and to allow spontaneous passage of fragments into the intestine (151,156,157).…”

Costs and Effectiveness of Extracorporeal Gallbladder Stone Shock Wave Lithotripsy Versus Laparoscopic Cholecystectomy: A Randomized Clinical Trial

“…This selection limits the application of cholelithotripsy to only about 10-20% (127) of ail patients presenting for cholecystectomy, although the actual patient denominator is difficult to assess because of referral patterns (128). Despite sporadic attempts at increasing inclusion criteria (129)(130)(131)(132)(133), a recent large cohort of nearly 700 treated patients confirmed the need for such rigorous patient selection at this time (134).…”

“…Hall' of the patients undergoing lithotripsyand not converting to other modalities had only one session, 36% had three, while the remaining 14 % had two sessions. Using these proportions, the Patient selection in the present study was very stringent compared to other groups (129)(130)(131)(132)(133)(134) and was optimized to achieve the best possible results with a generator and a Iithotripsy treatment protocol having yielded good stone fragmentation and disappearance rates in the past (138). Although stone fragmentation was deemed satisfactory in 78% of cases, the stone disappearance rate was modest reaching only 38 % after 15 months.…”

Black Bile of Melancholy or Gallstones of Biliary Colics: Historical Perspectives on Cholelithiasis

“…Considering the increased cost and risk caused by directly cannulating the gallbladder, adjuvant therapy with cheno-and/or ursodeoxycholic acid was introduced as a safer modality [72,73]. Yet, complications including the risk of biliary obstruction, pancreatitis, or acute cholecystitis as consequences of successful stone fragmentation remained high [73][74][75][76]. The limited long-term success with recurrent stone formation in about 70 % after 4 years further dampened the initial enthusiasm [77].…”