Optimierte extrakorporale stosswellenlithotripsie von gallenblasensteinen: Ein prospektiver randomisierter therapievergleich

Is >>pulverization<< or >>fragmentation<< the best endpoint of extracorporeal shock wave application in ESWL of gallbladder stones? Has gallbladder motility a potential for the prevention of stone recurrence? Methods: Prospective, monocentric study with randomization between the conventional treatment strategy (endpoint of shock wave application: fragments ≤ 4 mm, concomitant oral chemolitholysis) and an intensified treatment strategy (endpoint of shock wave application: Pulverization, no chemolitholysis). Prevention of stone recurrence: At least once per month for one hour after a meal standardized position (back position, lowered chest). Results: 34 patients, age 46 ± 14 years (27 women, seven men) were included (F-ESWL: n = 18; P-ESWL: n = 16). Gallbladder motility, number, size and CT- measured calcifications of stones were comparable for both groups P-ESWL patients received more shock wave pulses than F-ESWL patients and more treatment sessions. P-ESWL resulted in a better fragmentation and pulverization of stones was reached significantly more often (p < 0.05). The time period for stone clearance was significantly depending on the fragmentation result (pulverization: 0.7 months vs. fragments ≤ 4 mm: 6.6 months vs. fragments > 4 mm: 8.0 months; p < 0.01). The stone free rate after twelve months was 87.5% for P-ESWL and 72.2% for F-ESWL (n.s.) and correlated significantly with the fragmentation result (P < 0.01). Pain sensations during stone clearance were significantly reduced by P-ESWL. Stonefree patients were followed up for 30 ± 13 months, the total recurrence rate was 7.1%. Conclusions: Aiming for pulverization of gallbladder stones by means of intensified extracorporeal shock wave application is at least equal or in tendency superior compared to disintegration to fragments ≤ 4 min. Gallbladder motility might be useful to prevent gallstone recurrence after successful ESWL.