Gallstones and Gallbladder Disease - Managing Common Bile Duct Stones

Extracorporeal Shock Wave Lithotripsy

Gallstone fragmentation by extracorporeal shock wave lithotripsy (ESWL) may be an appropriate therapy for some patients who cannot undergo surgery, but it is no longer widely used. The treatment works best on solitary stones that are less than 2 centimeters in diameter. Less than 15% of patients are good candidates for lithotripsy. The typical procedure is performed as follows:

• The patient sits in a tub of water.
• High-energy, ultrasound shock waves are directed through the abdominal wall toward the stones.
• The shock waves travel through the soft tissues of the body and break up the stones.
• The stone fragments are then usually small enough to be passed through the bile duct and into the intestines.
• Lithotripsy is generally combined with oral dissolution treatment to help dissolve the fragmented pieces of the original gallstone.

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Complications. Complications include pain in the gallbladder area and pancreatitis, usually occurring within a month of treatment. In addition, not all of the fragments may clear the bile duct. Adding erythromycin to the treatment regimen may help remove these fragments. About 35% of patients who are left with fragments are at risk for further problems, which can be severe. The chance of recurrence is high with this procedure, and in one study, 45% of patients eventually required surgery. Elderly people may have a lower risk for recurrence than younger adults.

Review Date: 06/10/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).