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 (