Objective: Determination of the efficacy of extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones and adjuvant treatment with oral bile acids.
Setting: Department of Surgery, University Hospital Dijkzigt, Rotterdam, the Netherlands.
Design: Descriptive clinical research.
Patients and methods: In 4 years, 133 patients (34 males and 99 females, mean age 49 years (range 24-81)) underwent 299 ESWL sessions, on an outpatient basis except for the first 16. All patients received adjuvant oral bile acid therapy (7-8 mg/kg body weight urso- and chenodeoxycholic acid, starting one day after ESWL). The number of ESWL sessions was 2.5 (mean; range: 1-7) with 2817 shock waves (75-4000), a session duration of 62 min (35-210). 73.7% of the patients (n = 98) required intravenous analgesic sedation.
Results: At a mean follow-up of 13.8 months (1-45), 27.6% of the patients were free of stones. At 1 year after the first ESWL session, 51.0% of the patients with a solitary stone and 8.3% of the patients with 2-10 stones were free of stones (p < 0.0001). Of the 43 patients who had become free of stones 6 developed recurrent stones (14.0%). Fifty-seven patients (42.9%) suffered from colic, 9 (6.8%) from obstruction of the common bile duct, including 4 who developed pancreatitis. Two patients had transient haematuria and one acute cholecystitis; 15 (11.3%) suffered from an oral bile acid-related diarrhoea, which could easily be resolved by lowering the dose of chenodeoxycholic acid. 30 patients (22.6%) underwent cholecystectomy.
Conclusions: Our results reconfirm that ESWL is safe and moderately effective in selected patients. Nowadays most patients choose laparoscopic cholecystectomy, which implies that ESWL will be confined to patients with an increased operative risk and to those who refuse surgery. ESWL should be limited to patients with solitary stones.