Extracorporeal shockwave lithotripsy for gallstones
The aim of ESWL is to break the stones into pieces small enough to pass out of the cystic duct and the sphincter of Oddi; the maximal size is about 5 mm.
Oral bile salt therapy should be given as an adjuvant after the procedure and lithotripsy repeated after 4-6 weeks if fragments larger than 5 mm are present.
The stone-free rates in these patients are at best approximately 35% at 6 months, 65% at 12 months and over 90% at 2 years.
Complications of lithotripsy include minor bruising, haematuria, and severe pain on passage of the fragments.
The procedure may be performed as an outpatient case.
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