Absence of apolipoprotein E4 genotype, good gallbladder motility and presence of solitary stones delay rather than prevent gallstone recurrence afterextracorporeal shock wave lithotripsy

Background/Aims: Extracorporeal shock wave lithotripsy (ESWL) with adjuvant bile salt dissolution therapy may be successful in selected gallstone pati ents, but the considerable risk of recurrence is a major drawback. Apolipop rotein E4 genotype and impaired gallbladder motility have been identified a s major risk factors for recurrence during shortterm follow up. We have now examined their relevance during long-term follow up. Methods: Eighty-four cholesterol gallstone patients (55 solitary and 29 mul tiple (two to ten) stones) were followed prospectively up to 10 years after complete stone disappearance. Various potential risk factors for recurrenc e were evaluated. Results: Gallstone recurrence was found in up to 80 % of patients at 10 yea rs follow-up. Absence of the apolipoprotein epsilon4 allele, initial solita ry stones, good gallbladder emptying (i.e. minimal postprandial volume less than or equal to6 ml) and 2-year postdissolution ursodeoxycholic acid prop hylaxis tin ten patients) all delayed but did not prevent recurrence. In co ntrast, regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was i dentified as an independent protective factor, with greatly decreased recur rence (at 10 years: 58 vs 93% in non-NSAID users, P = 0.03). Conclusions: Non-apolipoprotein E4 genotype, presence of Solitary stones an d good gallbladder emptying delay rather than prevent recurrence after init ially successful ESWL. Regular use of NSAIDs may prevent recurrence. (C) 20 01 European Association for the Study of the Liver. Published by Elsevier S cience B.V. All rights reserved.