Hiromu Mon, MD #{149}Dermot E. Malone, MB Christopher de Gara, MB #{149}Brijendra Rawat, William L. Orovan, MD #{149}Igor Laufer, MD

Frank P. McGrath, MB #{149}William MB #{149}James H. Maher, MD #{149} John #{149} Giles W. Stevenson, MB

Optimizing Gallbladder An International Survey’

T

Rates of stone clearance with extracorporeal shock wave cholecystolithotripsy (biliary lithotripsy [BLI) initially reported by European groups were encouraging. An Amencan multicenter BL study (the Dornier National Biliary Lithotripsy Study [DNBLSI) 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.

terms:

Gallbladder, 762.1299

.

Gallbladder,

calculi,

interventional Lithotripsy

years.

While

remains

1992;

open

the

MATERIALS

standard,

challeng-

and

ing this position. Both require general anesthesia, however, and have associated morbidity and mortality. Extracorporeal shock wave bithotripsy

is successful

renal stones treatment of et ab in 1986 studies have and efficacy

in the

treatment

tripsy (BL) (2-7). BL treatment cobs and stone clearance rates

sent

protovary

(8). This

tionab

Bibiary

[DNBLS])

study

(the

Dornier

Lithotripsy

reported

Na-

Study

6-month

stone-

at 6 months

had

been

reported for a similar stone burden by a group using the same lithotriptor (2,4). The purpose of this survey was to record the results obtained in centers in Europe and Japan, to compare

762.289

procedure,

with

identify strategies.

184:735-739

those

of DNBLS,

successful,

safe

and

principal

Three

1990).

its to three Stuttgart)

investigator

of the authors

German institutions,

institution,

and

institution.

Wuppertal,

one

9000 was at each

made

(Herne, one

by

Interna-

(Munich,

used the Dornier MPL A detailed questionnaire

to the

center.

patient survey literature

site vis-

Munich, and Italian (Rome)

Japanese

(Fukuoka)

Germany,

was

the

sixth center in this survey. Results published by two of these centers are also inin this survey

selection energy

report questions

(4,7). related

to patient

criteria, the level of shock used, the number of shock

administered, treatments,

the maximum BL end-point

adjuvant

oral

bile

acids,

wave waves

number of criteria, use of

and

pre-

and

post-BL imaging methods. Major and minor complications that followed BL were also recorded. The stone-free rates after 6-, 12-, and 18-month follow-up for solitary

and multiple stones were requested. The data were entered into a data base (Data Ease 4.2; DataEase International, Turnbulb, Conn), and the results were compared

free rates of approximately 30% in patients with a single radiobucent stone less than 20 mm in diameter who received adjuvant ursodeoxycholic acid (8). In Europe, about 70% clearance

sufficient

at the Third

BL Symposium

cluded The

considerably between institutions. An American mubticenter BL study performed with a Dornier MPL 9000 (Dornier Medizintechnik, Germering, Germany) electrohydraulic bithotriptor failed to duplicate European results

of presentations

Each center lithotriptor.

and was first used in the gallstones by Sauerbruch (1). Since then, numerous demonstrated the safety of gallbladder stone litho-

and

were selected for this of a review of published

tional

of

METHODS

that had standardized

protocols

numbers means

laparoscopic

is seriously

AND

Six BL centers treatment

chobecystectomy

chobecystectomy

these Radiology

Lithotripsy:

management options for symptomatic gallbladder stones changed radically in recent

stone

Index

Stone

HE

have

E. Torres, MD Paul Whelan, MD

#{149}

to

BL treatment

with

the

DNBLS

only

trial

using

findings. “intent

DNBLS

was

to treat”

the

analysis

for the calculation of results (cases of patients who were randomized in the “ursodeoxychobic acid and BL” arm but did not undergo BL were regarded as treatment failures). For comparative purposes, the shock wave energy bevels used predominantly ters were

during categorized

moderate

(20-24

BL in the different as low (16-19 kV),

or high

(26

cenkV),

kV).

RESULTS

i

From

the Medical

College

of Oita,

McMaster University Medical Centre, F.P.M., BR., G.W.S.); Emory University, Ontario, Canada (C.d.G.); University

Ontario, From

Canada the

1991

(J.P.W., W.L.O.); RSNA

scientific

Oita,

Japan

(H.M.);

Department

of Diagnostic

the

Imaging,

1200 Main

St W, Hamilton, Ont, Canada L8N 315 (D.E.M., Atlanta (WET.); Henderson General Hospital, Hamilton, of Iowa, Iowa City OHM.); StJoseph’s Hospital, Hamilton,

and Hospital

assembly.

of the University

Received

December

of Pennsylvania, 6, 1991;

revision

Philadelphia requested

January

The patient selection criteria and BL treatment protocols of the six

centers

and

in Table

Abbreviations: DNBLS Study.

reprint

requests

to D.E.M.

summarized

300 patients

had

3,

Dornier Medical C RSNA, 1992

Address

are

than

(IL.).

1992; revision received March 6; accepted April 24. Supported in part by Domier Medical Systems. H.M. supported by Dornier Medical Systems and Sterling-Winthrop. BR. supported in part by Systems.

DNBLS

1. More

=

BL Dornier

=

biliary

National

lithotripsy, Biliary

Lithotripsy

735

Table 1 Patient Selection

Criteria

and

Protocol

Treatment

of Six Centers

Stone Study DNBLS

1-3 stones

Shock

Stones

Demographics

Treated

Used

each up to Yes,

Optimizing gallbladder stone lithotripsy: an international survey.

Rates of stone clearance with extracorporeal shock wave cholecystolithotripsy (biliary lithotripsy [BL]) initially reported by European groups were en...
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