Gallstone disease lithotripsy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Occasionally, extracorporeal shock wave lithotripsy can be used to fracture gallstones into small pieces and sand to increase the surface area that is exposed to the bile acids, facilitating dissolution and clearance of the stones. Stone may also be manually extracted or a stent may be placed to relief symptoms of biliary colic. This may be an option in those who refuse or are unfit for surgery, or when medical dissolution therapy has been ineffective.
Mechanical nonsurgical gallstone management
- Extracorporeal shock wave lithotripsy (ESWL)
- Shock waves generated outside the body are focused on the gallstones to reduce them to sand.[1][2][3][4][5][6][7][8][9]
- This sand is expected to enter the duodenum or to be more dissolvable with oral bile acids.
- ESWL has been very successful with renal stones, however with gallbladder stones it has a limited use since only a select few patients are candidates for ESWL, some cases reported biliary attacks after the procedure.
- ESWL is also expensive and has low efficacy in treating gallstones even when in combination with oral bile acids.
- Percutaneous cholecystostomy and gallstone extraction
- This is a technique used with mostly nonsurgical candidates.
- The procedure is performed by creating a track to the outside of the body, under fluoroscopic guidance the track is dilated using graded percutaneous dilators.
- Stones are then extracted and any debris left behind is irrigated to the outside using saline.
- Endoscopic placement of a cystic duct stent
- During endoscopic retrograde cholangiopancreatography (ERCP) in patients with gallstone-related disease (such as biliary colic, acute cholecystitis, acalculous cholecystitis, and gallstone pancreatitis) and serious comorbidities, a stent is sometimes placed to provide some relief.
References
- ↑ Pereira SP, Veysey MJ, Kennedy C, Hussaini SH, Murphy GM, Dowling RH (1997). "Gallstone dissolution with oral bile acid therapy. Importance of pretreatment CT scanning and reasons for nonresponse". Dig. Dis. Sci. 42 (8): 1775–82. PMID 9286247.
- ↑ Sackmann M, Delius M, Sauerbruch T, Holl J, Weber W, Ippisch E, Hagelauer U, Wess O, Hepp W, Brendel W (1988). "Shock-wave lithotripsy of gallbladder stones. The first 175 patients". N. Engl. J. Med. 318 (7): 393–7. doi:10.1056/NEJM198802183180701. PMID 3340116.
- ↑ Nicholl JP, Ross B, Milner PC, Brazier JE, Westlake L, Kohler B, Frost E, Williams BT, Johnson AG (1994). "Cost effectiveness of adjuvant bile salt treatment in extracorporeal shock wave lithotripsy for the treatment of gall bladder stones". Gut. 35 (9): 1294–300. PMC 1375711. PMID 7959241.
- ↑ Davis CA, Landercasper J, Gundersen LH, Lambert PJ (1999). "Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results". Arch Surg. 134 (7): 727–31, discussion 731–2. PMID 10401823.
- ↑ Burhenne HJ, Stoller JL (1985). "Minicholecystostomy and radiologic stone extraction in high-risk cholelithiasis patients. Preliminary experience". Am. J. Surg. 149 (5): 632–5. PMID 3993844.
- ↑ Conway JD, Russo MW, Shrestha R (2005). "Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease". Gastrointest. Endosc. 61 (1): 32–6. PMID 15672053.
- ↑ Shrestha R, Trouillot TE, Everson GT (1999). "Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awaiting orthotopic liver transplantation". Liver Transpl Surg. 5 (4): 275–81. doi:10.1002/lt.500050402. PMID 10388500.
- ↑ Shrestha R, Bilir BM, Everson GT, Steinberg SE (1996). "Endoscopic stenting of gallbladder for symptomatic cholelithiasis in patients with end-stage liver disease awaiting orthotopic liver transplantation". Am. J. Gastroenterol. 91 (3): 595–8. PMID 8633518.
- ↑ Kalloo AN, Thuluvath PJ, Pasricha PJ (1994). "Treatment of high-risk patients with symptomatic cholelithiasis by endoscopic gallbladder stenting". Gastrointest. Endosc. 40 (5): 608–10. PMID 7988828.