EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY FOR GALLSTONES - IMPORTANCE OF SELECTION CRITERIA

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.