[Shockwave therapy of gallstones]

Extracorporeal shock-wave lithotripsy (ESWL) is a helpful adjunct for those bile duct stones which cannot be extracted by routine endoscopic measures including mechanical lithotripsy. For very large or impacted stones in the bile duct or stones in the intrahepatic biliary tree, and also for stones located in proximity to a bile duct stenosis, shock-wave therapy has proven to be safe and successful. More than 85% of the patients become free of stones after this therapy; they otherwise would have had to undergo high-risk open bile duct surgery. For gallbladder calculi, the pivotal factor for complete fragment disappearance after shock-wave therapy is sufficient stone disintegration. Only if fragments not larger than 3 mm are achieved, complete expulsion and/or dissolution of these fragments may be expected in a high percentage of the patients. Optimal candidates include patients with a single, radiolucent stone in a well-contracting gallbladder. For this group, ESWL is a safe and effective noninvasive therapeutic alternative.