Ursodeoxycholic acid for adjuvant therapy with extracorporeal shock wave lithotripsy of gallstones

Extracorporeal shock wave lithotripsy (ESWL) of gallstones is a new and experimental treatment. Recent data seem to indicate that the use of ursodeoxycholic acid (UDCA) after ESWL may optimize the results of the shock wave treatment. Most of the published data on the clinical use of such therapy emanate from two studies conducted in West Germany in approximately 300 patients. These subjects received combination therapy with UDCA and chenodeoxycholic acid (CDCA) before and after ESWL. The stone fragments gradually disappeared by 18 months after lithotripsy. No adverse effects attributable to the UDCA-CDCA treatment were noted. Several considerations support the view that adjuvant chemical dissolution therapy will be necessary for best results with ESWL, including compatibility of the rate of stone dissolution postlithotripsy with that of chemical dissolution rather than mechanical ejection; the common presence of cholesterol-supersaturated bile in gallstone patients, promoting reconglomeration of fragments; and decreased contractility of the gallbladder, which may improve after successful cholelitholytic therapy with UDCA. Placebo-controlled studies on the use of UDCA with ESWL are currently being conducted.