Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones

Burnett, David; Ertan, Atilla; Jones, R. S.; O’Leary, J. Patrick; Mackie, Robert; Robinson, John E.; Salen, Gerald; Stahlgren, LeRoy H.; Thiel, David H. Van; Vassy, Louis E.; Greenberger, Norton J.; Hofmann, Alan F.

doi:10.1007/bf01536365

Cited by 59 publications

(8 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…55% of the patients showed clearance of the gall bladder after 6 months, whereas in patients with larger fragments (> 5 mm) the effect was significantly reduced. Another study [7] and our own results confirm these data.…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones

Rambow

Staritz²,

Grosse³

et al. 1991

Digestion

View full text Add to dashboard Cite

A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17–76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had solitary concrements (diameter 23.3 ± 6.4 mm) while in 18 patients 2 or 3 stones (diameter below 10 mm) were observed. Stone fragmentation was achieved after an average of 1.35 treatment sessions (range 1–3) in 78 (97.5%) patients. No clinically relevant adverse effects were observed. Immediately after ESWL, ultrasound revealed misleading results with regard to stone fragmentation. 98.7% of patients (n=77) were seen for follow-up investigations 3, 6 and 9 months after ESWL, and 82% at 12 months. A total of 40 (53%) patients became free of stones. Subgroup analysis showed that 68% of the patients were free of stones (stone diameter 10–20 mm), 54% (20–30 mm) and 33 % (multiple stones), respectively. We therefore conclude that ESWL should be restricted to highly selected patients presenting with small (10–20 mm) solitary concrements.

show abstract

Section: Discussionsupporting

confidence: 81%

“…New lithotriptors permit shock wave appli cation using either no premedication or only mild sedation and administration of analgesic drugs [1][2][3][4][5]. Despite this, repro ducible short-and long-time results are not yet established [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones

Rambow

Staritz²,

Grosse³

et al. 1991

Digestion

View full text Add to dashboard Cite

show abstract

“…No further complications of ESWL needed operative intervention. In other studies, the incidence of cholecystectomy was found to be 8 (4%) of 223 patients [12], 6 (4%) of 135 patients [13], or 6 (8%) of 78 patients [14]. The number of patients with biliary colic was not as high as found by others, but further complications appeared in similar frequencies as found in studies on early results after ESWL [12,13].…”

Section: Discussionsupporting

confidence: 75%

Electrohydraulic extracorporeal non‐water bath shock‐wave lithotripsy of gallstones: Two years' experience

et al. 1991

View full text Add to dashboard Cite

A prospective study was performed to evaluate the effectiveness of extracorporeal shockwave lithotripsy (ESWL) using a non-water bath lithotripter in combination with oral chemolitholysis on gallstone clearance. Patients were treated without general anesthesia or parenteral analgesia. We treated 74 patients selected according to the widely accepted criteria. Only 2 patients could not be sufficiently treated because of pain. After a 2 year period, 24 (32%) patients showed complete stone clearance, 35 (47%) patients had residual fragments, 5 (7%) patients underwent cholecystectomy, 2 (3%) patients were lost to follow up, and 8 (11%) patients discontinued the treatment before fragment clearance. According to the life-table estimate, 77% of our patients with successful ESWL and uncomplicated oral chemolitholysis are stonefree after 1 year. We consider the major advantage of this nonsurgical treatment of gallstone disease is that general anesthesia or parenteral analgesia has become unnecessary.

show abstract

“…The fascinating idea of noninvasive shock-wave litho tripsy of gallstones, which held out great hope at the beginning [72][73][74][75], is now also being restricted to a very selected group of patients [46,76].…”

Section: Esw L O F Gallbladder Stonesmentioning

confidence: 99%

“…Within this small group of patients 80% are stone free after 1 year [46,[72][73][74][75][76][77]79], Patients with multiple (up to 3) and larger stones (up to 30 mm in diameter) have a success rate of only 30-50% within 6-12 months [80]. Again these pa tients generally need an additional long-term treatment with medical litholysis for 8-10 months, and the recur rence of stones, which is frequently associated with the recurrence of biliary pain, occurs in about 23-30% of the patients after 5 years [80,81].…”

Section: Esw L O F Gallbladder Stonesmentioning

confidence: 99%

Decision-Making in Patients with Gallstones: Development of a Clinical Algorithm Using the Instrument of a Consensus Development Conference

et al. 1995

View full text Add to dashboard Cite

Since decision-making in patients with gallstone disease is a very common medical problem, a carefully planned consensus development conference was held to develop a clinical algorithm using an electronically transmitted group response of the panel and the general audience. Only symptomatic patients are candidates for treatment. Minimal diagnostic requirements are ultrasound, determination of leukocytes, alkaline phosphatase and bilirubin in the blood, and preoperative intravenous cholangiography. Detected common duct stones should nowadays be removed by endoscopic retrograde cholangiopancreatography. Symptomatic gallbladder stones are managed by laparascopic cholecystectomy as the new standard treatment. Conventional cholecystectomy should be done in patients with liver cirrhosis and portal hypertension, suspicion of cancer, certain cases of severe, acute or chronic inflammation, severe adhesions in the upper abdomen and pregnancy. Medical stone dissolution and extracorporeal shock-wave lithotripsy should be restricted to a small group of patients with a high surgical risk and who have small, roentgen-negative stones and a patent gallbladder.

show abstract

Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones

Cited by 59 publications

References 12 publications

Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones

Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones

Electrohydraulic extracorporeal non‐water bath shock‐wave lithotripsy of gallstones: Two years' experience

Decision-Making in Patients with Gallstones: Development of a Clinical Algorithm Using the Instrument of a Consensus Development Conference

Contact Info

Product

Resources

About