REPEATED PIEZOELECTRIC LITHOTRIPSY FOR GALLSTONES WITH AND WITHOUT URSODEOXYCHOLIC ACID DISSOLUTION - A MULTICENTER STUDY

The use of bile acid dissolution therapy in extracorporeal shockwave l ithotripsy of gallstones, remains controversial. Our study examined wh ether chemolitholysis after sufficient disintegration enhanced stone c learance within 6 months of the first lithotripsy. A total of 143 pati ents who developed one to three radiolucent stones measuring less than or equal to 30 mm in diameter were randomly separated into two treatm ent groups: 47% were given lithotripsy alone, and 53% lithotripsy plus ursodeoxycholic acid (UDCA). Repeated piezoelectric lithotripsy was g iven, with no limit on the total number of treatment sessions, to pulv erize or disintegrate stones into fragments <3mm. Stones were disinteg rated in 97% of all patients, and the fragments were less than or equa l to 2mm in 50% of these patients. According to an intention-to-treat analysis, 52% in the lithotripsy alone group and 58% in the UDCA group were free of stones 6 months after the first lithotripsy (P = 0.61). Of the patients with fragments less than or equal to 2 mm, 71% in the former and 86% in the latter group were free of stones 6 months after the first lithotripsy, with no significant difference between the grou ps. Biliary pain occurred in 25% of all patients, including 3 with acu te cholecystitis. We concluded that the sufficient disintegration of g allstones achieved with repeated lithotripsy enhanced the early cleara nce of fragments, regardless of whether chemolitholysis was employed.