Electromagnetic shock wave lithotripsy of gallbladder stones: a wide range of inclusion criteria

From April 1988 until November 1990, 83 patients with symptomatic gallbladder stones were treated in the University Hospital "Dijkzigt" Rotterdam with extracorporeal shock wave lithotripsy (ESWL) followed by oral administration of bile acids (urso- and chenodeoxycholic acid). According to our inclusion criteria, patients with up to 10 stones without any limit to the size of the stone(s) were accepted for treatment. On average, these patients underwent two sessions of ESWL with an electromagnetic lithotriptor (Lithostar and Lithostar Plus, Siemens AG, Erlangen, Germany). Fragmentation of stones was achieved in 70/83 (84% patients). The best results were achieved in patients with a solitary gallstone (50% of these patients were stone-free 12 months after ESWL). Four percent of the patients with two to three stones, and 12% of the patients with four to 10 stones were free of stones 12 months after ESWL. Twenty-eight (34%) patients suffered from biliary colics after ESWL, and three patients (3.5%) developed pancreatitis. The administration of oral bile acids was complicated by transient diarrhoea in 15 (18%) patients. ESWL followed by oral bile acid therapy is a relatively effective and safe therapy for a highly select population of patients with gallbladder stones, which can be performed on an outpatient basis. Although the results for multiple stones were poor, the usage of wide inclusion criteria (up to 10 stones of any size) did not affect the success rate of ESWL for multiple stones.