Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

Elewaut, A; Crape, A; Afschrift, Marcel; Pauwels, W.; Vos, M. De; Barbier, F

doi:10.1136/gut.34.2.274

Cited by 26 publications

(8 citation statements)

References 25 publications

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“…There have been many reports of the effectiveness of ESWL from Japan and other countries [7,21,22,[77][78][79][80][81][82], including long-term outcomes over 5-10 years of followup [83][84][85][86]. The elimination rate 1 year after ESWL treatment of patients with single gallstones, gallstones smaller than 20 mm in diameter, and noncalcified pure cholesterol gallstones (characteristic ultrasound image, radiolucency, CT value of less than 50 HU) ranged from 63% to 90% [7,21,22,[77][78][79][80][81][82][83][84].…”

Section: Commentarymentioning

confidence: 99%

“…The elimination rate 1 year after ESWL treatment of patients with single gallstones, gallstones smaller than 20 mm in diameter, and noncalcified pure cholesterol gallstones (characteristic ultrasound image, radiolucency, CT value of less than 50 HU) ranged from 63% to 90% [7,21,22,[77][78][79][80][81][82][83][84]. For calcified cholesterol gallstones, which are relatively common in Japan, the elimination rate 1 year after ESWL was reported to be 60% [87].…”

Section: Commentarymentioning

confidence: 99%

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Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

214

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

214

178

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: B the Medical Treatment Of Cholelithiasismentioning

confidence: 99%

“…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.…”

Section: Cost Analysismentioning

confidence: 99%

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

Barkun

Sampalis

et al. 1997

Int J Technol Assess Health Care

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Thirty-five patients were randomized to extracorporeal shock-wave lithotripsy (ESWL) and 25 to laparoscopic cholecystectomy (LC). Stone disappearance occurred in only 12 of 32 ESWL patients [38% (95% Cl: 21–56%)] during a 15-month follow-up. Greater incremental gains in quality of life after 6 months were observed among LC patients (p <.01). Total duration of disability was 6.8 ± 8.5 days for ESWL, and 22.7 ± 16.6 days for LC (p <.01). Nine (28%) patients crossed over electively to the LC group, but only 44% of these underwent LC within the next 3 years. ESWL cost Can $58.9/ day of disability saved. ESWL is limited by its selective applicability and modest stone disappearance rate. Its cost-effectiveness is largely dependent on patient acceptance of recurrent episodes of biliary colic due to the persistence of stone fragments.

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“…The limited long-term success with recurrent stone formation in about 70 % after 4 years further dampened the initial enthusiasm [77]. Especially with the introduction of laparoscopic techniques, surgery had become the more costeffective approach to manage symptomatic or complicated cholecystolithiasis [78].…”

Section: Treatmentmentioning

confidence: 99%

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

Bielefeldt

2014

Dig Dis Sci

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Barely 130 years after its first description, cholecystectomies are among the most commonly performed surgeries in the USA. The success of this operation with subsequent technical improvements, such as laparoscopic approaches, caused a paradigm shift in the management of gallstone disease. However, symptoms persist in 10-40 % of successfully operated patients. Reviewing monographs, textbooks, and articles published during the last 300 years, several important factors emerge as likely contributors to limited or poor treatment responses. Early on, clinicians recognized that cholelithiasis is quite common and thus often an incidental finding, especially if patients present with vague or atypical symptoms. Consistent with these observations, patients with such atypical symptoms are less likely to benefit from cholecystectomy. Similarly, lasting improvements are more reliably seen in patients with symptoms of presumed biliary origin and documented gallstones compared to individuals without stones, an important point in view of increasing rates of surgery for biliary dyskinesia. While cholelithiasis can cause serious complications, the overall incidence of clinically relevant problems is so low that prophylactic cholecystectomy cannot be justified. This conclusion corresponds to epidemiologic data showing that the rise in elective cholecystectomies decreased hospitalizations due to gallstone disease, but was associated with a higher volume of postoperative complications, ultimately resulting in stable combined mortality due to gallstone disease and its treatment. These trends highlight the tremendous gains in managing gallstone disease, while at the same time reminding us that the tightening rather than expanding indications for cholecystectomy may improve outcomes.

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Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

Cited by 26 publications

References 25 publications

Evidence-based clinical practice guidelines for cholelithiasis 2016

Evidence-based clinical practice guidelines for cholelithiasis 2016

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

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

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