Long-term evaluation of extracorporeal shock-wave lithotripsy for cholesterol gallstones

Background: Extracorporeal shock-wave lithotripsy (ESWL) is a treatment tha t preserves the gallbladder. Problems after ESWL treatment include stone re currence and the development of biliary symptoms. Methods: Two hundred and sixty-two patients with cholesterol-type gallstone s, the best indication for ESWL treatment, and 42 control patients with cho lesterol-type gallstones who received no treatment entered this study. We e valuated the factors associated with recurrence of gallstones after stone c learance and the development of biliary symptoms after ESWL treatment. Results: The 3-, 5- and 7-year cumulative probabilities of gallstone recurr ence were 20.6, 27.1 and 33.1%, respectively, with the recurrence probabili ty significantly lower in patients with good gallbladder contractility. In patients with recurrence, ursodeoxycholic acid (UDCA) treatment was effecti ve. In 69 patients with residual gallstones, the 3-, 5- and 7-year cumulati ve risks of biliary symptoms were 17.3, 24.9 and 30.5%, respectively. With residual gallstones, the risk of biliary symptoms developing was significan tly lower in patients with a less than or equal to 3 mm fragment size at th e end of ESWL treatment and in those treated consistently with UDCA for 6 m onths or more after treatment with ESWL. The risk of biliary symptoms was s ignificantly lower in ESWL-treated patients with residual stones who had a less than or equal to 3 mm fragment size after treatment compared to those of control patients. Conclusions: Ursodeoxycholic acid was effective in clearing stones in patie nts with gallstone recurrence. In patients with residual stones, the fragme ntation of stones to less than or equal to 3 mm and UDCA administration eff ectively reduced the risk of subsequent biliary symptoms. (C) 2001 Blackwel l Science Asia Pry Ltd.