cholelithotripsy definition
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If you experience symptomatic gallstones, there are a number of different treatment options available. Your exact course of treatment will depend on your symptoms and the characteristics of the gallstones you have. The goal of treatment is to relieve symptoms and prevent complications from developing. Treatment for gallstones includes:
- Medication
- Surgery
- Extracorporeal shock wave lithotripsy
- Percutaneous therapy
- Endoscopic gallbladder stenting
- Treating complications of gallstones
Gallstone Disease Treatment: Medication
There are several medications available for symptomatic gallstones, which are designed to:
- Interfere with the development of gallstones in the gallbladder
- Dissolve the stones
These medications are only useful in patients who have small, non-calcified cholesterol stones and whose gallbladder is functioning normally. Therapy takes at least six to 12 months. There is a chance that the gallstones will recur within five years.
Gallstone Disease Treatment: Surgery
Cholecystectomy is surgery to remove your gallbladder. It is the only treatment option to cure symptomatic gallstones. Laparoscopic cholecystectomy is the most common procedure instead of a traditional, open procedure. During a laparoscopic cholecystectomy, your surgeon:
- Makes a few small incisions in your abdomen rather than one large one
- Inserts a miniature video camera and laparoscopic instruments into the incision
- Removes the gallbladder and closes the incisions with stitches
Advantages of a laparoscopic procedure include:
- Less pain
- Shorter hospital stay
- Faster return to normal activities
Sometimes, a surgeon begins the procedure using a laparoscopic approach but then switches to an open approach because of scarring, infection or other complications. No matter which approach your doctor uses, he or she has your best possible outcome in mind.
Gallstone Disease Treatment: Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) is a nonsurgical alternative to manage gallstones. You can receive this treatment as long as your gallbladder is functioning normally and your stones are small.
You do not need anesthesia for ESWL, and the procedure may be performed as an outpatient. This method uses high-energy sound waves to produce shock waves. The shock waves are strong enough to fracture and disintegrate the gallstones.
Patients who cannot undergo surgery may be good candidates for ESWL.
Gallstone Disease Treatment: Percutaneous Therapy
In certain high-risk patients, surgery may be too dangerous. A percutaneous (through the skin) treatment approach may be used. During this procedure, your doctor opens the gallbladder, dilates the tract and removes any gallstones using a device called a cholecystoscope.
Another percutaneous method is called contact dissolution therapy. During this procedure, a catheter is inserted into your gallbladder, and a solvent is injected directly to the gallbladder. The solvent dissolves the cholesterol stones.
Gallbladder Disease Treatment: Endoscopic Gallbladder Stenting
Endoscopic gallbladder stenting is another nonsurgical approach to treat gallstones. It is useful in treating high-risk patients who cannot undergo surgery, usually due to an illness. During this procedure, your doctor performs an ERCP and inserts a stent from the gallbladder to the duodenum. The stent relieves biliary symptoms and complications.
Treating Complications of Gallbladder Disease
Certain complications may arise in patients with gallbladder disease. Your doctor will discuss with you the risks of complications.
- Acute cholecystitis: This is the most common complication, and it occurs when the gallstone becomes impacted in the cystic duct. The bile is then trapped in the gallbladder, causing damage and inflammation. Usually, a cholecystectomy (removal of the gallbladder) is the best treatment.
- Choledocholithiasis: This occurs when gallstones become displaced to the common bile duct rather than to the gallbladder. Choledocholithiasis can cause life-threatening conditions. An ERCP can be performed to diagnose and treat these gallstones.
Less common complications include:
- Cholecystoenteric fistulas, which form when a large stone erodes through the gallbladder into the bowel. Treatment involves cholecystectomy and bowel resection.
- Mirizzi’s syndrome is the result of a gallstone blocking the cystic duct, compressing the common bile duct and causing inflammation. ERCP is used to diagnose and treat it.
- Porcelain gallbladder occurs when the gallbladder wall calcifies (hardens), usually because of gallstones. This can lead to gallbladder cancer, so removal of the gallbladder is recommended.
cholecystogastrostomy
(kō″lē-sĭs″tōgăs-trŏs′tō-mē) [″ + ″ + gaster, belly, + stoma, mouth] Surgical formation of a passage between the gallbladder and the stomach.
(kō″lē-sĭs″tō-grăm) [″ + ″ + gramma, something written] A radiograph of the gallbladder. This procedure is being replaced by ultrasonography.
(kō″lē-sĭs-tŏg′ră-fē) [″ + ″ + graphein, to write] Radiography of the gallbladder, a procedure replaced by ultrasonography.
(kō″lē-sĭs″tō-jĕ-jū-nŏs′tō-mē) [″ + ″ + L. jejunum, empty, + Gr. stoma, mouth] Surgical formation of a passage between the gallbladder and the jejunum.
(kō″lē-sĭs″tō-kīn′ĭn) ABBR: CCK. A hormone secreted into the blood by the mucosa of the upper small intestine. It stimulates contraction of the gallbladder and pancreatic secretion.
A direct test of pancreatic function that assesses both the endocrine and exocrine functions of the pancreas. A double-lumen tube is inserted into the patient’s gastrointestinal tract. One lumen samples the duodenal juices, the other removes gastric secretions. First secretin and then cholecystokinin are given to the patient intravenously; then the duodenal juices are analyzed to determine whether adequate levels of bicarbonate and trypsin are secreted. SYN: secretin injection test.
(kō″lē-sĭs″tō-lĭ-thī′ă-sĭs) [″ + ″ + lithos, stone, + –iasis, condition] Gallstones in the gallbladder.
cholecystolithotripsy
(kō″lē-sĭs″tō-lĭth′ō-trĭp″sē) [″ + ″ +″ + tripsis, a rubbing] Crushing of a gallstone in the unopened gallbladder with an extracorporeal shock-wave lithotriptor; its use is primarily investigational.
How Do I Know if I Have Gallstones?
If your symptoms suggest a gallstone problem, your doctor might first examine your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.
Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit.
The most common technique is an ultrasound exam. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.
What Are the Treatments for Gallstones?
In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.
Conventional Medicine for Gallstones
When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.
Gallstones and Watchful Waiting
Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its “silence.” Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.
Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor’s care and report any recurrences of gallstone symptoms immediately.
Nonsurgical Therapy for Gallstones
If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your doctor may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming, and recurrence is common.
Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug Actigall (ursodiol) is taken as a tablet; depending on its size, the gallstone may take months or even years to go away. Because some stones are calcified, this treatment often doesn’t work.
Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve small pieces. This therapy is rarely used.
Doctors can also attempt to remove gallstones during an ERCP. During the procedure an instrument is inserted through the endoscope to attempt removal of the stone.
While these therapies may work for some, all of the above nonsurgical therapies are usually unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.
Surgery to Remove the Gallbladder
While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. Each year approximately 750,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.
