Piezoelectric lithotripsy: Stone disintegration and follow-up results in patients with symptomatic gallbladder stones

One hundred symptomatic patients with radiolucent gallbladder stones were treated with a new piezoelectric lithotripter and oral chemolitholytic agents. Stone disintegration was achieved in 99 of these patients (99%) with a mean (±SD) maximum fragment size of 5.1 ± 4.1 mm. Significant differences were found when the mean (±SD) fragment sizes of single stones ≤ 20 mm (4.2 ± 2.5 mm) were compared with those of single stones >20 mm (5.8 ± 3.4 mm; P < 0.05) and multiple stones (6.2 ± 3.8 mm; P < 0.05), respectively. None of the patients required anesthesia, analgesics, or sedatives before or during the treatment. The stone-free rates for all patients followed up for up to 4–12 months (mean ± SD, 10.7 ± 2.9 months) were 18% (1 month), 25% (2 months), 38% (4 months), 52% (8 months), and 67% (12 months). Partly significant differences were obtained in stone-free rates for single stones (≤ 20 mm) compared with larger stones (> 20 mm) and multiple stones (P < 0.05), respectively. Serious adverse reactions (i.e., cholestasis and pancreatitis) were observed in only 3 patients (3%). These conditions were induced by fragment impaction in the common bile duct. In 2 of these patients, endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy was required. It is concluded that piezoelectrically generated shock waves are suitable for the effective and safe disintegration of gallbladder stones in humans. The anesthesia-free and analgesia-free shock-wave application opens up the possibility to perform biliary lithotripsy as an outpatient procedure. The stone-free rate achieved in combination with oral bile acids is most promising for single stones (≤ 20 mm).