Aspects of the current treatment modalities for symptomatic gallstones

Extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones was clinically introduced in 1985. Before that, cholecystectomy had been the unchallenged standard therapy for symptomatic gallbladder stones for over a century. Expectations with regard to ESWL ran rather high after publication of the first results in a large series of patients. This actuarial analysis of 175 patients indicated that not less than 91 % of the patients rendered stone free at a negligible complication rate. Lay press interpreted these data as if surgery would soon become obsolete for the majority of gallstone patients, an interpretation also heard from optimistic physicians at scientific meetings. As a consequence of this optimism, an unbridled purchase of gallstone lithotriptors occured by hospitals all over Gerntany, the country of origin ofESWL. This optimism seemed justified because a decade earlier, ESWL revolutionized urological practice. Shortly after the introduction of ESWL, surgery for urinary tract stones became restricted to less than 5 % of the patients.