Gallstone disease lithotripsy
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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.
- 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
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