Extracorporeal Shock Wave Lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy is an alternative to gallstone surgery. Shock waves are used to break the stones into pieces tiny enough to pass through the ducts without causing blockages. This treatment does not require general anesthesia, and it can often be done as an outpatient. It is often combined with ursodiol therapy to dissolve the fragmented pieces. Clinical studies have indicated that the combination therapy can speed up clearance of gallstones and result in higher success rates compared to drug therapy alone in carefully selected patients.

Special Considerations

Not everyone is a candidate for ESWL because it can cause intense pain and does not have a high success rate. Gallstones may return months to several years later.

Patients who are candidates for ESWL include patients who:

  • Cannot tolerate surgery and have a gallbladder that is functioning
  • Have a cystic duct that is not blocked
  • Have cholesterol stones between 4 millimeters (mm) and 30 mm in diameter
  • Have three or fewer stones

Patients who are not candidates for ESWL include people who:

  • Are pregnant
  • Have cholecystitis (blockage of the gallbladder duct by a stone that results in inflammation of the gallbladder)
  • Have cholangitis (bacterial infection of bile ducts)
  • Have common bile duct obstruction
  • Have pancreatitis (an infection of the pancreas)

Endoscopic Retrograde Cholangiopancreatography (ERCP)

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove the stones before or during gallbladder surgery.

During the procedure, your throat will be sprayed with a local anesthetic and you will be given medication intravenously to help you relax. Then, an endoscope—a long, thin, flexible, lighted tube connected to a computer and TV monitor—will be passed through your mouth. The doctor will guide the endoscope through the stomach and into the small intestine. You may feel bloated during and after the procedure because air is used to inflate the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. The affected bile duct is then located, and an instrument on the endoscope is used to open the duct. The stone is captured in a tiny basket and removed with the endoscope.

Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.

When to Contact Your Healthcare Provider

Contact your health care provider if you experience:

  • Severe abdominal pain
  • Fever