Extracorporeal shock wave lithotripsy for gallstones

Abstract

Biliary stone disease is common in most western societies, among whom gallstones are present in approximately 15-20% of adults. 40-60% of all persons with gallstones are asymptomatic, but 30-50% of them develop symptoms over a period of 2-5 years. For decades, cholecystectomy was the only solution. In the past decade new options, such as oral dissolution, direct dissolution, invasive endoscopy and lately lithotripsy and adjuvant treatment with oral dissolution agents, have become available. This paper summarizes the rationale of lithotripsy, its indications and complications, the impressive results of its use abroad and the authors' year of experience with 110 patients. Immediate fragmentation was achieved in 90.3%. Complete dissolution after 1 month was seen in 20%, after 3 months in 38.5% and after 6 months in 61.6%. After 1 year of treatment 85.8% of our patients were stone-free. Experience abroad, as well as our own, shows that lithotripsy and oral dissolution can be the treatment of choice in a selected group of patients with symptomatic gall stones.