H. Wenzl et al., THE EFFECT OF CISAPRIDE ON CLEARANCE OF G ALLSTONE-FRAGMENTS AFTER EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL), Wiener Klinische Wochenschrift, 106(4), 1994, pp. 103-106
Stone fragments remaining in the gallbladder are an important problem
after ESWL. Cisapride (CIS) improves gallbladder contraction and hence
we decided to investigate whether clearance of stone fragments after
ESWL for radiolucent gallbladder stones can be increased by cisapride.
Six to 15 months (median 12) after ESWL 48 patients with remaining ga
llstone fragments of less than 5 min in diameter were randomized eithe
r to Group A, who received cisapride 10 mg t.i.d. orally for 3 months
in addition to oral litholysis (OLL) with ursodeoxycholic acid 500 mg/
day and chenodeoxycholic acid 500 mg/day, or to Group B, who continued
solely with OLL. All patients had started OLL within the fortnight-pr
eceding ESWL. Gallbladder contractility, as measured by oral cholecyst
ography with a fatty meal, was intact in all patients prior to ESWL. M
aximal diameter and number of fragments were assessed by ultrasound (5
mHz) in different positions of the patient at the beginning of the st
udy and after 3 months. Total clearance of fragments, which includes c
learance of all sludge. occurred in only 3 patients, two of whom recei
ved only OLL. After 3 months the number of fragments decreased in 6 pa
tients in Group A and in 7 patients in Group B. Three patients stopped
taking cisapride before completion of the study, two because of diarr
hoea, and one because of dysuria. All symptoms were readily reversible
after discontinuing cisapride. In conclusion. cisapride combined with
OLL does not enhance clearance of the gallbladder when fragments are
still present one year after ESWL.