Cholecystolithiasis: Three years experience with ultrasound-guided electromagnetic shock-wave lithotripsy

Abstract

In a three-year period, 207 patients with cholecystolithiasis were referred to an interdisciplinary team at our hospital to evaluate the possibility of non-surgical treatment. Fifty-eight patients were found eligible for extracorporeal shock-wave lithotripsy (ESWL); 50 of them underwent ESWL on an outpatient basis with adjuvant bile acid therapy. Thirty patients (60%) had single stones, 14 (28%) had two or three stones, and 6 (12%) had five-ten stones. The mean total stone volume of all patients was 2,5 cm³, equivalent to a single stone of 1.7 cm diameter; 6 patients (12%) had slightly calcified stones. Successful stone fragmentation (fragments <- 4 mm) was achieved in 45 patients (90%). In the remaining 5 patients (10%) with residual fragments > 4 mm, ESWL was considered a failure and elective cholecystectomy was eventually performed or recommended. All patients received adjuvant oral bile acid therapy. The stone clearance rates after 3, 6, 12 and 18 months were 29%, 50%, 83% and 95% in patients with single stones and 22%, 40%, 64% and 88%, respectively, in all patients. The duration of treatment in 32 patients who have cleared all their gallstone fragments to date, was 8.5 months (range: 0.4–20.4 months); all of these patients are also free of their initial symptoms. Sideeffects and complications of ESWL included biliary colic in 17 patients (34%), mild acute pancreatitis in 1 patient (2%) and acute cholecystitis requiring emergency cholecystectomy in another patient (2%). The electromagnetic device and the protocol we used is well suited for ambulatory treatment of patients with a limited stone volume. A fragment size <- 4 mm was usually achieved with 2 treatment sessions and appears to be a reasonable endpoint of ESWL. Although laparoscopic cholecystectomy is now a routine procedure in our hospital, we believe that ESWL remains a valid treatment option in selected patients.