The Course of Biliary and Gastrointestinal Symptoms after Treatment of Uncomplicated Symptomatic Gallstones: Results of a Randomized Study Comparing Extracorporeal Shock Wave Lithotripsy with Conventional Cholecystectomy

Objectives: We performed a randomized study that compared extracorporeal shock wave lithotripsy (ESWL) with conventional cholecystectomy for uncomplicated symptomatic gallstones. The primary outcome of the study was the influence of therapy on biliary colic and gastrointestinal symptoms. Methods: In the period October 1989-March 1992, 26 patients were randomized for cholecystectomy and 23 for ESWL. Pain diaries and symptom questionnaires were taken before, and 3, 6, 12, 18, and 24 months after therapy. ESWL patients regularly underwent ultrasound examination for determining stone clearance. Median follow-up was 18 months (12–24). Results: Biliary colic was cured in 90.9% and 45.4% of the patients within 3 months after cholecystectomy or ESWL, respectively (p < 0.01). Stomach swelling, fatty food upset, and nausea responded to cholecystectomy after 6, 12, and 18 months, respectively. Nausea responded to ESWL after 6 months. Vomiting, pyrosis, ructus, diarrhea and constipation did not respond to gallstone therapy. When the two treatment arms were compared, only fatty food upset responded significantly better to cholecystectomy than to ESWL at 18 months (p < 0.05). With regard to the other gastrointestinal symptoms, no significant differences could be detected. Conclusions: We conclude that cholecystectomy is superior to ESWL in improving biliary colic and fatty food upset. Furthermore, because ESWL is not able to clear all stones and harbors the possibility of stone recurrence, cholecystectomy remains the preferred treatment modality in healthy patients with uncomplicated symptomatic gallstones.