Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment

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Twenty years ago, extra-corporeal shockwave lithotripsy (ESWL) combined with oral bile acid dissolution therapy was introduced as a non-invasive and safe treatment for selected patients with symptomatic gallbladder stones.The success rate of ESWL, defined as a stone-free gallbladder, decreases with the number and size of the stones, impaired gallbladder motor function and the presence of calcifications.The risk of stone recurrence is the major drawback of ESWL of gallbladder stones.Today, laparoscopic cholecystectomy has become the standard procedure for the treatment of symptomatic gallbladder stones while ESWL has kept its role only in the treatment of bile duct stones not amenable to endoscopic extraction.Twenty years ago, in January 1985, extracorporeal shock wave lithotripsy (ESWL) was first applied successfully in a patient with gallbladder stones. In the following years, the conditions which influence the success rate of ESWL have been extensively investigated. It was shown that the characteristics of the stones, gallbladder emptying and the degree of stone fragmentation are the most important factors which determine the clearance of all fragments from the gallbladder after ESWL. Severe side effects, such as biliary pancreatitis and liver haematoma, were found to be rare and no deaths related to the procedure have been reported. One or more episodes of biliary pain were observed in about one third of patients within the first 3–4 months after ESWL. Follow-up studies after successful treatment, however, have shown that stone recurrence is considerable, limiting the use of ESWL as a non-invasive therapeutic option. Stone recurrence varies between different subgroups of patients indicating that gallbladder motor function and other less well defined factors may be of importance. The recurrence of stones after ESWL is one of the reasons why laparoscopic cholecystectomy has become the standard treatment of symptomatic gallbladder stones today. ESWL has kept its role only in the treatment of bile duct stones resistant to endoscopic extraction. Unless stone recurrence can be decreased by better patient selection and/or other measures to prevent gallstone recurrence, ESWL of gallbladder stones has little chance of surviving.

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