BILE-ACID THERAPY VERSUS PLACEBO BEFORE AND AFTER EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY OF GALLBLADDER STONES

Aim: To study the effects of bile acid therapy on the fragmentation ra te of cholesterol gallbladder stones by extracorporeal shock wave lith otripsy (ESWL) and on the clearance of fragments after ESWL. Patients and methods: One hundred and two patients with biliary pain, between o ne and five radiolucent gallbladder stones, and a gallbladder with a p atent cystic duct were randomized to 3 weeks of double-blind treatment with bile acids (ursodeoxycholic acid 500 mg and chenodeoxycholic aci d 500 mg per day) or placebo before ESWL. After successful fragmentati on by ESWL (largest fragment less than or equal to 5 mm) the patients were re-randomized to 6-month double-blind therapy with bile acids or placebo. Results: Ninety-nine patients completed 3 weeks of pre-ESWL t reatment, There was no statistically significant difference in fragmen tation rate between the two groups. After 6 months of post-ESWL therap y, 12 of 49 patients (24%) had cleared the fragments from their gallbl adder with bile acids compared with five of 50 patients (10%) who had placebo therapy (P = 0.10). There was no significant difference in the occurrence of pain between groups. The figures were no better in pati ents with a single stone less than or equal to 20 mm in diameter,Concl usion: Extracorporeal shock wave lithotripsy with or without adjuvant bile acid therapy does not seem to be an attractive therapy for patien ts with uncomplicated symptomatic gallstone disease.