AN AGGRESSIVE PROTOCOL OF ESWL AND DISSOLUTION THERAPY OF GALLBLADDER STONES

Objectives: to assess the overall efficacy and which factors are independent predictors of success of ESWL and oral dissolution therapy of gallbladder stones using an aggressive protocol (high energy shock waves -median 22 Kv- and allowance to up to 6 sessions with an electro-hydraulic lithotripter). Patients and methods: inclusion criteria were 1) biliary pain; 2) 1 to 3 radiolucent stones or with slight calcification; 3) total stone volume under 15 cm(3), equivalent to a single stone 3 cm diameter and 4) opacified cholecystography. Data was collected prospectively for 139 consecutive patients undergoing this treatment and the stone-free curves up to 12 months were analyzed as a function of age, sex, body-mass index, total stone volume, number of stones and the presence of slight calcification. Results: patients underwent a mean of 2.6 sessions (range: 1-6) and 2834 shock waves (range: 589-8175). The global stone-free rate at 12 months was 54% (95% confidence interval: 45-64%). Factors that significantly -and adversely- influenced outcome were total stone volume (P<0.001), number of stones (P=0.005) and slight calcification (P=0.038), using Cox's regression. Beyond significance, these three factors showed a marked effect on the stone-free curves. Conclusions: our data suggest that, even with this aggressive protocol, these factors are clearly detrimental. Thus, the results of our study agree with the current trend to restrict this combination therapy to patients with single, non-calcified stones with a small volume, or up to 2 cm diameter as is usually quoted.