Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-25T13:09:18.286Z Has data issue: false hasContentIssue false

Nonsurgical Treatment of Cholelithiasis: An Analysis of Clinical Opportunity

Published online by Cambridge University Press:  10 March 2009

Debra F. Weinstein
Affiliation:
Harvard Medical School
James A. Brink
Affiliation:
Harvard Medical School
James M. Richter
Affiliation:
Harvard Medical School

Abstract

This article examines the potential impact of recently developed nonsurgical treatments for gallstones on patient care and resource utilization. Using epidemiological and efficacy data from the literature and current patient selection criteria, the authors evaluate UDCA, extracorporeal shock-wave lithotripsy, and direct instillation of methyltertbutyl ether in terms of short-term clinical results, health policy, and economic implications.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abate, M.Medical management of gallstones. Drug Intelligence and Clinical Pharmacy, 1986, 20, 106–15.CrossRefGoogle ScholarPubMed
Bouchier, I. A. D. The medical treatment of gallstones. Annual Review of Medicine, 1980, 3159–77.Google Scholar
Brink, J. A., Simeone, J. F., Mueller, P. R. et al. Physical characteristics of gallstones removed at cholecystectomy: Implications for extracorporeal shock-wave lithotripsy. American Journal of Roentgenology, 1988, 151, 927–31.CrossRefGoogle ScholarPubMed
Delius, M., Enders, G.& Brendel, W.The passage of stone fragments from the gallbladders of dogs. Surgery, Gynecology, & Obstetrics, 1988, 166, 241–44.Google ScholarPubMed
Delmont, J. P., Magnier, M., Mosnier, H. et al. Results of gallstone lithotripsy in 212 patients using the EDAP LT.01. In Ferrucci, J. T., Delius, M., & Burhenne, H. J. (eds.). Biliary lithotripsy. Chicago, IL: Yearbook Medical Publishers, 1989, 95102.Google Scholar
Ell, C., Kerzel, W. et al. Piesoelectric lithotripsy of gallstones. Initial clinical experiences. Deutche Medizinische Wochenschrift, 1988, 113, 1503–07.CrossRefGoogle Scholar
Ellwood, P. M.Outcomes management: a technology of patient experience. New England Journal of Medicine, 1988, 318, 1549–56.CrossRefGoogle ScholarPubMed
Erlinger, A., Lego, A., Husson, J. M. & Fevery, I.Franco–Belgian cooperative study of ursodeoxycholic acid in the medical dissolution of gallstones: A double-blind randomized dose responsive study and comparison with chenodeoxycholic acid. Hepatology, 1984, 4, 308–14.CrossRefGoogle ScholarPubMed
Fromm, H.Gallstone dissolution therapy: Current status and future prospects. Gastroenterology, 1986, 91, 1560–67.CrossRefGoogle ScholarPubMed
Gracie, W. A. & Ransohoff, D. F.The natural history of silent gallstones: The innocent gallstone is not a myth. New England Journal of Medicine, 1982, 307, 798800.CrossRefGoogle Scholar
Greiner, L., Wenzel, H. & Jakobit, C.Biliary shock wave lithotripsy. Fragmentation and lysis–a new procedure. Deutche Medizinische Wochenschrift, 1987, 112, 1893–96.CrossRefGoogle ScholarPubMed
Harrison, J., Morris, D. L., Haynes, J. et al. Electryhydrolic lithotripsy of gallstones–in vitro and animal studies. Gut, 1987, 28, 267–71.CrossRefGoogle Scholar
Hood, K., Keightly, A., Dowling, R. H. et al. Piezo-ceramic lithotrips of gallbladder stones: Initial experience in 38 patients. Lancet, 1988, i, 1322–24.CrossRefGoogle Scholar
Inui, K., Nakazawa, S., Naito, Y., et al. Nonsurgical treatment of cholecystolithiasis with percutaneous transhepatic cholecystoscopy. Gastroenterology, 1988, 83, 1124–27.Google ScholarPubMed
Kozark, R. A.Romancing the stones. Gastrointestinal Endoscopy, 1989, 35, 127–28.CrossRefGoogle Scholar
Lear, J. L., Ring, , E. A., Macoviak, , J. A. & Baum, S.Percutaneous transhepatic electrohydraulic lithotripsy. Radiology, 1984, 150, 589–90.CrossRefGoogle ScholarPubMed
Marks, J. W., Lan, S., & the Steering Committee, National Cooperative Gallstone Study Group. Low dosxe chenodiol to prevent gallstone recurrence after dissolution therapy. Annals of Internal Medicine, 1984, 100, 376–81.CrossRefGoogle ScholarPubMed
McSherry, C. K. & Glenn, F.The incidence and cause of death following surgery for nonmalignant biliary tract disease. Annals of Surgery, 1980, 191, 271–75.CrossRefGoogle ScholarPubMed
Meredith, T. H., Williams, G. V., Maton, P. N. et al. Retrospective comparison of “cheno” and “urso” in the medical treatment of gallstones. Gut, 1982, 23, 382–89.CrossRefGoogle ScholarPubMed
Mulley, A. G.Shock-wave lithotripsy–assessing a slam-bang technology. New England Journal of Medicine, 1986, 314, 845–47.CrossRefGoogle ScholarPubMed
Nakagama, S., & Makino, I.Dissolution of cholesterol gallstones by ursodeoxycholic acid. Lancet, 1977, ii, 367–69.CrossRefGoogle Scholar
National Center for Health Statistics. Advance data from the 1987 National Hospital Discharge Survey, No. 159, Rev 9–28–88. Washington, DC: National Center for Health Statistics.Google Scholar
Pitt, H. A., McFadden, D. W. & Gadacz, T. R.Agents for gallstone dissolution. American Journal of Surgery, 1987, 153, 233–46.CrossRefGoogle ScholarPubMed
Podda, M., Zuin, M. et al. Efficacy and safety of a combination of chenodeoxycholic acid and ursodeoxycholic acid for gallstone dissolution: A comparison with ursodeoxycholic acid alone. Gastroenterology, 1989, 96, 222–29.CrossRefGoogle ScholarPubMed
Ponchon, T., Martin, X., Mestas, J. L. et al. Dissolution of gallstones following extracorporeal lithotripsy of the gallbladder: Preliminary clinical data. In Ferrucci, J. T., Delius, M. & Burhenne, H. J. (eds.), Biliary lithotripsy. Chicago, IL: Yearbook Medical Publishers, 1989, 7982.Google Scholar
Ransohoff, D. F., Gracie, W. A., Wolfensen, L. B., & Aeuhauser, D.Prophylactic cholecystectomy or expectant management for silent gallstones. Annals of Internal Medicine, 1983, 99, 199204.CrossRefGoogle ScholarPubMed
Roda, E., Bazzoli, F., Morselle, Labate A. M., et al. Ursodeoxycholic acid versus chenodeoxycholic acid as cholesterol gallstone dissolving agents: A comparative randomized study. Hepatology, 1982, 2, 804–10.CrossRefGoogle Scholar
Roger, W. L., Winkenmorder, W., Mackbarth, G. M., & Krakauer, K.Effectiveness in health care: An initiative to evaluate and improve medical practice. New England Journal of Medicine, 1988, 319, 1197–202.Google Scholar
Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Radio-logic appearance of gallstones and its relationship with biliary symptoms and awareness of having gallstones: Observations during epidemiological studies. Digestive Diseases and Science, 1987, 32, 349–53.CrossRefGoogle Scholar
Ruppin, D. C., & Dowling, R. H.Is recurrence inevitable after gallstone dissolution by bile-acid treatment? Lancet, 1982, i, 181–85.CrossRefGoogle Scholar
Sackman, M., Delius, M., Sauerbruch, T. et al. Shock wave lithotripsy of gallbladder stones. The first 175 patients. New England Journal of Medicine, 1989, 318, 393–97.CrossRefGoogle Scholar
Schoenfield, L. J., Lachin, J. M. & the Steering Committee, National Cooperative Gallstone Study Group. Chenodiol (chenodeoxycholic acid) for dissolution of gallstones: The National Cooperative Gallstone Study. Annals of Internal Medicine, 1981, 95, 257–82.CrossRefGoogle ScholarPubMed
Thistle, J. L.Ursodeoxycholic acid treatment of gallstones. Seminars in Liver Disease, 1983, 3, 146–56.CrossRefGoogle ScholarPubMed
Thistle, J. L., May, G. R., Bendor, C. E. et al. Dissolution of cholesterol gallbladder stones with methyltertbutyl ether administered by percutaneous transhepatic catheter. New England Journal of Medicine, 1989, 320, 633–39.CrossRefGoogle Scholar
Tint, G. S., Salen, G., Colalitti, A. et al. Ursodeoxycholic acid: A safe and effective agent for dissolving cholesterol gallstones. Annals of Internal Medicine, 1982, 97, 351–56.CrossRefGoogle ScholarPubMed
Tokyo Cooperative Gallstone Study Group. Efficacy: indications of ursodeoxycholic acid treatment for dissolving gallstones: a multicenter double-blind trial. Gastroenterology, 1980, 78, 542–48.CrossRefGoogle Scholar
Zak, R. A., Marks, J. W. & Schoenfield, L. J.Current status of cholesterol gallstones by ursodeoxycholic acid. Seminars in Liver Disease, 1983, 3, 132–45.CrossRefGoogle Scholar