GALLSTONE LITHOTRIPSY

Extracorporeal shock-wave lithotripsy (ESWL) has been applied to patie nts with gallstones since the mid-1980s. Lithotriptors differ by their means of shock-wave generation, the mechanisms by which they are coup led to the patient, and their imaging system. Entry in most treatment protocols is limited to symptomatic patients with one to three radiolu cent stones having a diameter of 30 mm or less and a functioning gallb ladder according to oral cholecystography. Treatments are given on an outpatient basis using intravenous analgesia and include adjuvant bile acid therapy. Deaths have not been reported, and the incidence of ser ious complications, related to the presence of fragments in the biliar y system, is low. The studies show that ESWL is a safe and effective t reatment for patients with a single gallstone less than or equal to 20 nun in diameter, but the efficacy for larger single stones and multip le stones is poor. To date, the Food and Drug Administration has not a pproved lithotriptors for the treatment of gallstones in the United St ates.