E. Mulagha et H. Fromm, Extracorporeal shock wave lithotripsy of gallstones revisited: Current status and future promises, J GASTR HEP, 15(3), 2000, pp. 239-243
The improvement and refinement of extracorporeal shock wave lithotripsy (ES
WL) has made this non-invasive treatment modality not only more effective,
but also applicable to a larger population of gallstone patients. It can be
performed safely on an outpatient basis. Advances in lithotripsy technolog
y have made it possible to fragment stones into very small, sand-like parti
cles (pulverization), which clear the gall-bladder faster than large fragme
nts. Recent studies provide evidence that adjuvant bile acids may not be ne
cessary in most cases in which pulverization is achieved. Good gall-bladder
emptying appears both to promote the clearance of gallstones after ESWL an
d to decrease their recurrence. Although generally found to be more expensi
ve than surgery if bile acids are used, ESWL should be cost-effective, as b
ile acids may not be necessary in all patients. Elderly patients with radio
lucent, solitary and less than 30 mm gallstones can particularly benefit fr
om lithotripsy. (C) 2000 Blackwell Science Asia Pty Ltd.