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Related Experiment Videos

Gallstone lithotripsy: the Rotterdam experience

P W Plaisier1, R L van der Hul, R den Toom

  • 1Department of Surgery, University Hospital, Erasmus University Rotterdam, The Netherlands.

Hepato-Gastroenterology
|June 1, 1994
PubMed
Summary

Extracorporeal shockwave lithotripsy (ESWL) is safe and moderately effective for selected patients with gallstones, particularly solitary ones. Due to advancements in surgery, ESWL is best reserved for high-risk individuals or those refusing surgery.

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Area of Science:

  • Urology
  • Gastroenterology
  • Medical Technology

Background:

  • Gallstone disease management has evolved, with surgical options like laparoscopic cholecystectomy gaining prominence.
  • Extracorporeal shockwave lithotripsy (ESWL) offers a non-invasive approach for gallstone treatment.
  • Adjuvant oral bile acid therapy is often used in conjunction with ESWL.

Purpose of the Study:

  • To evaluate the safety and efficacy of extracorporporeal shockwave lithotripsy (ESWL) combined with oral bile acid therapy for gallstone dissolution.
  • To assess outcomes based on stone burden (solitary vs. multiple stones) and patient characteristics.
  • To determine the recurrence rate and major complications associated with ESWL.

Main Methods:

  • A cohort of 133 patients (34 males, 99 females; mean age 49) underwent 299 ESWL sessions between 1988 and 1992.

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  • Patients received adjuvant oral bile acid therapy.
  • Data collected included number of sessions, shock waves, duration, sedation requirements, stone clearance, cholecystectomy rates, recurrence, and complications.

    • Main Results:

    • At follow-up (mean 17.7 months), 27.8% of patients were stone-free, and 22.6% underwent cholecystectomy.
    • One-year stone-free rates were significantly higher for solitary stones (51.0%) compared to multiple stones (8.3%; p < 0.0001).
    • Major complications included pancreatitis (3.0%) and acute cholecystitis (0.8%). Recurrent stones occurred in 14%.

    Conclusions:

    • Extracorporeal shockwave lithotripsy (ESWL) is a safe and moderately effective treatment for selected gallstone patients.
    • ESWL demonstrates superior efficacy for solitary stones; treatment of multiple stones yielded poor results.
    • Given the success of laparoscopic cholecystectomy, ESWL should be reserved for patients with increased surgical risk or those who decline surgery.