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Pathophysiologic effects of biliary shockwave lithotripsy in a canine model
W C Chapman1, K L Parish, A J Kaufman
1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232.
The American Surgeon
|January 11, 1991
Summary
Extracorporeal shockwave lithotripsy for biliary stones shows promise but requires caution. Transthoracic approaches may cause lung contusions, while transabdominal methods appear safer for gallbladder treatment.
Area of Science:
- Gastroenterology
- Medical Devices
- Surgical Innovation
Background:
- Extracorporeal shockwave lithotripsy (ESWL) is being investigated for biliary stone disease.
- Limited data exists on the potential side effects of ESWL in this application.
Purpose of the Study:
- To evaluate the acute and chronic side effects of ESWL targeting the gallbladder wall in dogs.
- To compare the safety profiles of transthoracic and transabdominal ESWL approaches.
Main Methods:
- Dogs were exposed to varying numbers of shockwaves directed at the gallbladder wall.
- Two targeting approaches were used: transthoracic and transabdominal.
- Histopathological examination and biochemical analyses were performed post-treatment.
Main Results:
- Transthoracic ESWL resulted in pulmonary hemorrhagic contusions.
- Transabdominal ESWL caused only focal hemorrhage in the gallbladder wall and adjacent liver.
- No significant changes in pancreatic or liver enzymes were observed with transabdominal ESWL.
- Oral cholecystograms 6 days post-treatment showed normal gallbladder function.
Conclusions:
- Transabdominal ESWL for biliary stones appears to have minimal side effects under normal conditions.
- Caution is advised in patients with bleeding disorders.
- Avoiding lung tissue in the shockwave path is crucial during treatment.