J. Thorens et al., EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY FOR GALLSTONES - IMPORTANCE OF SELECTION CRITERIA, Schweizerische medizinische Wochenschrift, 123(14), 1993, pp. 642-648
In recent years, a number of alternatives to surgery for gallstones ha
ve been developed. Among them, extracorporeal shock-wave lithotripsy (
ESWL) was promising, being non-invasive and risk-free. Nevertheless, i
ts results vary according to the size, number and composition of the s
tones and according to the bile acids treatment used for fragment diss
olution. To better evaluate the importance of these factors, we have w
idened the selection criteria currently used (1 to 3 non-calcified sto
nes with a diameter below 30 mm) by including patients with large ston
es (up to 40 mm in diameter), multiple stones (up to 10 stones) and ca
lcified stones. We also compared, for efficacy of fragment dissolution
after ESWL, treatment by ursodeoxycholic acid alone as opposed to a m
ixture with chenodeoxycholic acid. Our results were (1) significant le
ssening of the fragmentation rate and of the number of gallbladders fr
ee of stones 1 year after ESWL when selection criteria are widened; (2
) a mixture of ursodeoxycholic and chenodeoxycholic acids may favour f
ragment dissolution after ESWL compared to treatment by ursodeoxycholi
c acid alone.