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Computed tomographic evaluation of gallstone calcification for biliary lithotripsy
P L Caslowitz1, E K Fishman, D R Kafonek
1Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD 21205.
The Journal of Lithotripsy & Stone Disease
|March 10, 1991
Summary
Gallstone calcification criteria may be too strict for biliary lithotripsy patient selection. This study evaluates computed tomography (CT) scans to assess gallstone fragmentation effectiveness.
Area of Science:
- Gastroenterology
- Medical Imaging
- Surgical Innovation
Background:
- Current Food and Drug Administration (FDA) trials for biliary lithotripsy are nearing completion.
- Existing eligibility criteria exclude patients with gallstones exhibiting >3-mm partial rim calcification on plain film (KUB) or oral cholecystogram (OCG).
- This exclusion is based on suboptimal gallstone clearance rates when combining lithotripsy with chemodissolution for calcified stones.
Purpose of the Study:
- To evaluate the effectiveness of current gallstone calcification criteria in predicting gallstone fragmentation during biliary lithotripsy.
- To assess the utility of computed tomographic (CT) scans for evaluating gallstone density and fragmentation post-procedure.
Main Methods:
- Computed tomographic (CT) scans were performed on 20 patients immediately before and 24 hours after biliary lithotripsy.
- Gallstone density was evaluated using pre-lithotripsy CT scans.
- Fragmentation was assessed by observing the CT appearance of gallstones post-lithotripsy.
- The adequacy of fragmentation was further determined using pre- and post-lithotripsy sonography.
Main Results:
- The study investigated the relationship between gallstone calcification, density, and fragmentation success following biliary lithotripsy.
- CT scan findings were correlated with sonographic assessments of fragmentation adequacy.
- Results aim to inform future patient eligibility criteria for biliary lithotripsy.
Conclusions:
- The findings will guide the refinement of patient selection criteria for biliary lithotripsy, potentially broadening eligibility.
- This research contributes to optimizing treatment outcomes for gallstone disease.
- The study highlights the role of advanced imaging in assessing lithotripsy efficacy.