[Does drug-induced litholysis still have a place in treatment of gallstones?].

In past years, laparoscopic cholecystectomy has largely taken the place of conservative therapy. However, analysis of our data shows, that conventional litholytic therapy of cholesterol stones using bile acids: a) achieves a success rate of over 80%, as long as the patients are well selected prior to therapy (stones < 1 cm diameter, stone size < one fourth of gallbladder contraction of more than 50% as compared when fasting, isodensity of stones in CT) b) has a mortality rate of 0% c) has high patient compliance, because typical episodes of biliary colics and general dyspeptic complaints due to stones are reduced. Therefore, combination bile acid therapy for lysis of selected cholesterol gallbladder stones is still justified today. Particularly young women with small, suspended concrements or patients with recurrent cholesterol stones benefit by this treatment. Extracorporeal lithotripsy can be justified today only in combination with bile acid therapy. However, the number of treatable persons with gall stones is quite small (< 20% of all patients with stones), duration of therapy is three years and the recurrence rate 2-5 years after successful lysis is 25-50% (solitary stones recur less often than multiple ones). Considering a prevalence of 20% of persons with gall stones in the European Economic Community, there are 12 million patients potentially eligible for litholysis.