[Extracorporeal shock wave treatment of calcium containing gallbladder calculi]

A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones. All patients received adjunct medication of 10 mg/kg body weight chenodeoxycholic and ursodeoxycholic acid 14 days prior to ESWL as a single bedtime dose. An average number of 5,300 +/- 2,200 shock waves (1,200-15,000) was applied for stone disintegration. The corresponding energy amounted to 750 bar. 29 patients needed one, 21 two or more treatments. After ESWL a variety of clinical abnormalities was observed: flank pain (15%), transient microhaematuria (33%) and transient macrohaematuria (2%). Subsequent to ESWL 5 patients suffered from complications such as biliary obstruction 3 weeks to 9 months after treatment and had to undergo ERCP. Three times endoscopic papillotomy was performed to remove stones from the common bile duct. Up to now 4 patients have undergone cholecystectomy: acute cholecystitis (n = 3), recurrent colicky pain (n = 1). 20 patients have been followed up over a 12-month period; 12 of them are completely free of stones and fragments.