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An early gallstone clearance following repeat piezoelectric lithotripsy
Author(s) -
TSUCHIYA YUKIHIRO,
TAKANASHI HIDEKI,
HANIYA KAZUO,
NISHIARAI HIROMI,
MIKAMI SIGERU,
NATSUKI YUTAKA,
KUNIYUKI HIROSHI,
SAITO HIROBUMI,
SAITO NOBUHIKO,
OHTO MASAO
Publication year - 1994
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1994.tb01568.x
Subject(s) - medicine , lithotripsy , ursodeoxycholic acid , surgery , extracorporeal shockwave lithotripsy , urology , gastroenterology
Abstract Piezoelectric extracorporeal litotripsy was performed in 128 symptomatic patients with radiolucent gall‐bladder stones to assess the significance of disintegration in fragment clearance. Up to 10 repeat lithotripsy sessions were scheduled to achieve a fragment target size of <3 mm. Fragmentation assessed by the size of the largest fragments after the last session was graded into three classes. I: sludge‐like disintegration, 18%; II: <3 mm (mean ± s.d., 1.7 ± 0.5 mm), 56%; and III: < 3 mm (3.3 ± 0.6), 26%. All patients were initially subjected to lithotripsy alone. Bile acid dissolution therapy was started only when ultrasonography failed to show the evidence of decrease in the <3 mm fragments during a 1 month follow up. Finally, 69 patients (54%) were treated by lithotripsy alone, and the remaining 59 received additional dissolution therapy at a mean period of 2.5 months after the initial lithotripsy. The rate of complete clearance in class I, II and III patients was 91, 42 and 10% at 6 months and 100, 68 and 49% at 18 months, respectively. Significant differences were noted between the three fragmentation grades (I vs II, III, P <0.0001; II vs III, P <0.02). The patients with complete clearance within 6 months were seen only in those treated by lithotripsy alone, while the majority (87%) of patients with complete clearance during the later period were seen in those treated by additional dissolution therapy. We conclude that a high degree of fragmentation appears to lead stones to an earlier period clearance, and reduce the need for dissolution therapy.