Brijendra
Rawat,
MD
#{149} H.
Extracorporeal of Calcified Work
Joachim
Burhenne,
Shock Gallstones
E
XTRACORPOREAL
lithotripsy
bladder
Gallbladder,
Gallbladder, 762.1299
US studies,
calculi, 762.1298
762.289. #{149} Lithotripsy,
1990; 175:667-670
I
From
the
General
Department
Hospital,
of Radiology,
Van-
couver, BC, Canada V5Z 1M9. From the 1989 RSNA annual meeting. Received October 4, 1989; revision requested November 16; revision received February 16, 1990; accepted February 20. Address reprint requests to H.J.B. RSNA, 1990
shown
have not been for most biliary although
size; (c) a functioning gallbladder with a minimum of a 20% decrease in volume after a fatty meal, as determined at ultrasound (US) examination; (d) no associated complications of gallstone disease stone
shock wave of the gall-
promising
results
(eg, pancreatitis,
calcified
calculi
constitute
15% of gallbladder
calculi assessed phy. If assessment
with
plain radiograof calcification
is
made on the basis of computed tomognaphy (CT), up to 50% of patients with gallbladder calculi would be ineligible for lithotripsy (2). When the high prevalence of cholecystolithiasis in the general population of North America is considered (3), patients with symptomatic calcified stones constitute a substantial minority and, in our opinion, need to be
considered when other
for ESWL, nonsurgical
especially therapies
for
gallstones (eg, orally on locally administered dissolution agents) have also demonstrated limited success. Our treatment protocol for biliary lithotripsy does not exclude patients
with were
calcified interested
gallstones to know
because we if it is justi-
fied to deny ESWL to these patients. In this article, we describe the early observations in 38 symptomatic patients with calcified gallstones and tamed tients calculi ology
our
results
with
those
ob-
in a separate group of 162 pawith radiolucent gallbladder who were referred to the nadidepartment at this institution
ESWL. AND
acute
cholecystitis,
on
obstruction of the common bile duct); and (e) normal results at hepatic and pancreatic function tests and normal clotting parameters (4). Calcification of gallbladder calculi was assessed with plain radiography of the right upper quadrant. CT was
accepted as candidates lithotripsy protocols,
approximately
for biliary
855 W 12th Ave. Van-
(ESWL)
has
PATIENTS
couver
Lithotripsy
for the treatment of selected patients with cholecystolithiasis (1). Patients with calcified gallbladder calculi
compare terms:
Radiology
Wave
in Progress’
Thirty-eight patients with calcific cholecystolithiasis underwent extracorporeal shock wave lithotripsy (ESWL) of the gallbladder on an outpatient basis. Twenty-two (60%) patients had fragments smaller than 3 mm on follow-up ultrasound (US) studies after an average of 13,450 shock waves and four lithotripsy sessions. Nineteen of these 22 patients were followed up for an average of 18 weeks, and only three were found to be free of residual fragments at US. The other three patients were lost to follow-up. Sixteen patients are still undergoing biliary ESWL. Comparison of calcified and noncalcified gallbladder calculi revealed that calcified stones required 50% more shock waves for successful fragmentation, fragments cleared considerably more slowly from the gallbladder, and patients had a higher frequency of acute pancreatitis (5% vs 2%) and transient hematuria (8% vs 3%). Stones with dense homogeneous calcification required significantly fewer shock waves for successful fragmentation than stones with calcific lamination. ESWL can be applied occasionally in patients with calcific cholecystolithiasis if an alternative to surgery is required, but success has been limited. Index
MD
METHODS
Thirty-eight patients with findings of calcified gallbladder calculi at plain radiognaphy (of a total of 200 patients with gallbladder calculi) underwent biliary ESWL as definitive therapy. The selection criteria were (a) symptoms attributable to gallstone disease; (b) no more than six gallbladder calculi with a minimum diameter of 5 mm, but no upper limit of
not In culi
performed. the 38 patients, showed a thick
the gallbladder peripheral rim
calof cal-
cification (>2 mm) (n = 11); a thin peripheral rim of calcification (