Radiology, Vol 184, 735-739, Copyright © 1992 by Radiological Society of North America
Optimizing gallbladder stone lithotripsy: an international survey
H Mori, DE Malone, FP McGrath, WE Torres, C de Gara, B Rawat, JH Maher, JP Whelan, WL Orovan and I Laufer
Medical College of Oita, Japan.
Rates of stone clearance with extracorporeal shock wave
cholecystolithotripsy (biliary lithotripsy [BL]) initially reported by
European groups were encouraging. An American multicenter BL study (the
Dornier National Biliary Lithotripsy Study [DNBLS]) did not reproduce these
results. The BL treatment strategies and 6-month stone clearance rates of
six leading European and Japanese centers were compared with those of
DNBLS. All foreign centers used adjuvant oral chemolitholysis and greater
shock wave energies from the same lithotriptor as that in DNBLS. Six months
after BL, the stone clearance rates at all six centers were higher than
those of DNBLS. There were no significant differences in complication rates
between centers. These findings suggest that the poor results of DNBLS were
chiefly due to the use of low kilovoltage and few BL sessions. Increased
energy levels and a fragment size end point of less than 5 mm optimize BL.
Despite the popularity of laparoscopic cholecystectomy, BL can be
recognized as a successful treatment alternative for patients with a low
burden of radiolucent stones.
