INTENSIFIED ESWL OF GALLSTONES - DISSOCIATION OF PULVERIZATION, PAIN RELIEF AND STONE-CLEARANCE

Background/Aims: Recently, intensified shock wave lithotripsy for gall stone pulverisation and subsequent clearance without bile salt medicat ion. has been advocated. We report-our first 44 patients treated by th is regime: Patients with intact gallbladder function and symptomatic g allstones of arty size, number and composition. Methodology: Forty-fou r consecutive patients who received intensified shock wave lithotripsy for gallstone pulverisation. and clearance were included in this stud y. The patients all had intact gallbladder function and presented with symptomatic gallstones of any size, number and composition. Results: Pulverisation was achieved in 75% of all cases (12 months), but only 3 4% were stone free. The proportion of patients with stone pulverisatio n compared to subsequent complete clearance was 93% versus 60% in smal l (<l=20mm) solitary stones and 67% versus 15% in. two or more stones. The pain intensity was markedly reduced within the first month of-tre atment, irrespective of complete pulverisation or definite stone clear ance. Conclusions: The approach of stone pulverisation by multiple sho ckwave treatments is effective in solitary stones brit does not achiev e adequate stone clearance in. multiple gallstones. Despite the low st one clearance rates in multiple stones, intensified ESWL used alone ma y be effective for these patients, if they are not eligible for surger y and the purpose of treatment is pain relief.