Can Aspirin Prevent Gallstone Recurrence after Successful Extracorporeal Shockwave Lithotripsy?

Abstract

Extracorporeal shockwave lithotripsy (ESWL) is a feasible procedure for the treatment of gallbladder stones in humans. Well-selected patients can achieve stone-free rates in a high percentage. With the gallbladder in situ, these patients are at risk of stone recurrence. There is considerable evidence that aspirin prevents cholesterol gallstone formation in animal models and may prevent gallstone recurrence in man. We attempted to clarify the risk of gallstone recurrence after successful piezoelectric lithotripsy in patients taking either low-dose aspirin or no medication. The first 45 patients shown to be completely free from stones after ESWL were randomized into two groups. One group received 100 mg aspirin daily; the other group did not receive any further medical therapy. Patients were further examined on an average of 19.6 months and 21.9 months, respectively. In the aspirin group the recurrence rate was 18.2%, whereas 21.7% of the patients in the control group developed recurrent stones. Seventy-eight per cent of these patients also had a recurrence of biliary pain. By life-table analysis we had, after a follow-up period of 24 months, a stone recurrence rate of 25% (+/- 11) in the aspirin group and 34% (+/- 14) in the control group. Our results indicate that recurrence prophylaxis remains one of the central questions in ESWL. In this preliminary study, 100 mg of aspirin daily was not able to reduce the recurrence rate after successful ESWL. Further studies will have to show whether higher doses of aspirin or other ways of preventing gallstone after ESWL are possible.

The inflammatory inception of gallbladder cancer

“…Aspirin, a cyclooxygenase inhibitor, has been associated with a reduced risk of GBC [92], similar to what has been observed for colorectal cancer [93]. It has been hypothesized that this reduction in the risk of GBC may be due to attenuation in gallstone formation associated with nonsteroidal anti-inflammatory drug (NSAID) use [94–96]; however, many studies have failed to show a decreased risk of gallstones associated with NSAID use [97–103]. In fact, a population-based case-control study in Shanghai, China, that included over 350 GBC cases, over 1000 biliary stone patients, and over 1000 healthy adults observed an inverse association between aspirin use and GBC [odds ratio (OR), 0.37; 95% confidence interval (CI), 0.17–0.88 compared to healthy controls and OR, 0.44; 95% CI, 0.19–0.99 compared to patients with biliary stones], but no association between aspirin and biliary stones (OR, 0.92; 95% CI, 0.59–1.44 compared to healthy controls) [92].…”

Roles of Infection, Inflammation, and the Immune System in Cholesterol Gallstone Formation

“…Therefore, the proinflammatory effects of solid cholesterol itself, and likely other proinflammatory mediators, have an integral role in cholelithogenesis. However, subsequent studies failed to fully recapitulate these findings; it is difficult to make direct comparisons between these types of studies because they all used different doses of acetylsalicylic acid, dosing regimens, parameters of measured success, and lithogenic diets 101–105…”

Predictions and Associations of Cholecystectomy in Patients with Cholecystolithiasis treated with Extracorporeal Shock Wave Lithotripsy

“…This is the first study to concentrate on the true cholecystectomy rate after ESWL of gallbladder stones. Several studies have examined stone recurrence after successful lithotripsy (6)(7)(8)(9)(10)(11)(12)(13); only a few data are available on followups of up to 5 years. Recurrency rates differ from 23 to 42% after 4 years.…”