Long-term results after successful extracorporeal gallstone lithotripsy: outcome of the first 120 stone-free patients.

BACKGROUND

Long-term results after successful extracorporeal shock wave lithotripsy (ESWL) of symptomatic gallbladder stones are determined by stone and complaint recurrence. The long-term outcomes of the first successfully treated patients of our Department are presented.

METHODS

The first consecutive 120 patients with symptomatic gallbladder stones who became stone-free after ESWL plus oral bile acids in the years 1986 and 1987 were included in this study. They were followed up at 1-to 2-year intervals clinically and by ultrasonography until April 1998. Recurrence of stones and biliary symptoms and subsequent treatment were recorded. The effect of various factors on recurrence was analyzed.

RESULTS

Median follow-up time was 6.0 years for all patients and 8.8 years for patients without recurrence (range, 0-11.2 years for both). Actuarial recurrence probability was 1.9%-16.6% per year reaching 60.2% (49.9%, 70.3%) (95% confidence interval) after 10 years. Patients with stone recurrence revealed significantly more stones before ESWL than patients without recurrence (P < 0.03). Other factors were not significantly different. The majority of stone recurrences were symptomatic requiring retreatment, mostly cholecystectomy.

CONCLUSION

The probability of gallbladder stone recurrence after successful ESWL remains high during a decade of follow-up. Many patients require repeated nonsurgical treatment or cholecystectomy. Thus long-term results are unsatisfactory and ESWL should be offered only exceptionally.