Long-term gallbladder stone recurrence and risk factors after successful lithotripsy

Objective The risk of recurrence has limited the acceptability of conservat ive therapies of gallbladder stones. The aim of the present study was to de termine the rate of stone recurrence and its risk factors, after successful shock-wave lithotripsy. Design Prospective ultrasound follow-up at yearly intervals or whenever bil iary pain was reported. Methods One hundred and fifty-eight consecutive patients (single stone, n = 130; two or three stones, n = 28) were followed up to 70 months (median, 3 3 months) after stone disappearance and discontinuation of ursodeoxycholic acid. Results Forty-three patients developed recurrent stones. By actuarial analy sis, the recurrence rates las a percent) at 1,2, 3, 4 and 5 years were, res pectively: 6 +/- 2, 14 +/- 3, 27 +/- 4, 35 +/- 5, and 44 +/- 6 (observed +/ - SE). Cox's regression analysis identified high body mass indexes to be a risk factor (P = 0.02) for newly formed stones. Having had a single primary stone did not seem to be protective. Fourteen of the 43 patients (33%) had early symptoms of recurrence. Thirty-eight patients (89%) chose to undergo oral dissolution again, which was complemented by lithotripsy in eight pat ients (19%). Conclusion The 5-year gallbladder stone recurrence after lithotripsy and ur sodeoxycholic acid is not substantially smaller than that reported by post- bile acid studies. Obesity is a risk factor for recurrent stones as it is f or primary stones. Most patients with secondary stones choose to have conse rvative therapy again. Gallbladder stone recurrence still is one of the maj or drawbacks of these treatments and cost-effective strategies are needed t o prevent it. fur JGastroenterol Hepatol 12:209-215 (C) 2000 Lippincott Wil liams & Wilkins.