DOES ADEQUATE PATIENT SELECTION REDUCE THE RISK OF GALLSTONE RECURRENCE AFTER SUCCESSFUL EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

To determine the risk of gallbladder stone recurrence in these patient s, 58 of the first consecutive 61 patients with solitary stones achiev ing complete stone clearance after ESWL and adjuvant bile acid therapy were included in a prospective study. All patients were observed for at least 12 months following discontinuation of oral bile acids. Twent y-one patients fulfilled our postulated ideal criteria (solitary radio lucent stones between 10-20 mm initial diameter, initial stone density < 50 HU, gallbladder ejection fraction > 70%). The remaining patients (n = 37) fulfilled the criteria of the Munich study group. In patient s fulfilling our ideal criteria, stone recurrence was not observed in any patient, while in those fulfilling solely the criteria of the Muni ch group, five instances of stone recurrence were observed (13.5% [n = 37], p < 0.1). Initial stone count is only one factor influencing the probability of gallstone recurrence following ESWL and discontinuatio n of oral bile acids. Our data suggest that factors such as low initia l stone density at gallbladder CT and good gallbladder function not on ly accelerate initial stone clearance but also reduce the risk of ston e recurrence after ESWL once oral bile acids have been discontinued.