Extracorporeal shock wave lithotripsy of gallstones revisited: Current status and future promises

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.