Absence of apolipoprotein E4 genotype, good gallbladder motility and presence of solitary stones delay rather than prevent gallstone recurrence after extracorporeal shock wave lithotripsy

• Published in: Journal of hepatology 2001-07, Vol.35 (1), p.10-16
• Main Authors: Venneman, Niels G, vanBerge-Henegouwen, Gerard P, Portincasa, Piero, Stolk, Mark F.J, Vos, Aart, Plaisier, Peter W, van Erpecum, Karel J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; apoE4 genotype; Apolipoprotein E4; Apolipoproteins E - genetics; Biological and medical sciences; Cholelithiasis - physiopathology; Cholelithiasis - therapy; Extracorporeal shock wave lithotripsy; Female; Follow-Up Studies; Gallbladder - physiopathology; Gallstone; Gastroenterology. Liver. Pancreas. Abdomen; Genotype; Humans; Lithotripsy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Non-steroidal anti-inflammatory drugs; Other diseases. Semiology; Patient Satisfaction; Recurrence; Secondary Prevention; Time Factors; Ursodeoxycholic acid
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(01)00093-9

Background/Aims : Extracorporeal shock wave lithotripsy (ESWL) with adjuvant bile salt dissolution therapy may be successful in selected gallstone patients, but the considerable risk of recurrence is a major drawback. Apolipoprotein E4 genotype and impaired gallbladder motility have been identified as major risk factors for recurrence during short-term follow up. We have now examined their relevance during long-term follow up. Methods : Eighty-four cholesterol gallstone patients (55 solitary and 29 multiple (two to ten) stones) were followed prospectively up to 10 years after complete stone disappearance. Various potential risk factors for recurrence were evaluated. Results : Gallstone recurrence was found in up to 80% of patients at 10 years follow-up. Absence of the apolipoprotein ε4 allele, initial solitary stones, good gallbladder emptying (i.e. minimal postprandial volume ≤6 ml) and 2-year postdissolution ursodeoxycholic acid prophylaxis (in ten patients) all delayed but did not prevent recurrence. In contrast, regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was identified as an independent protective factor, with greatly decreased recurrence (at 10 years: 58 vs 93% in non-NSAID users, P=0.03 ). Conclusions : Non-apolipoprotein E4 genotype, presence of solitary stones and good gallbladder emptying delay rather than prevent recurrence after initially successful ESWL. Regular use of NSAIDs may prevent recurrence.