A flow-chart for determining indications for extracorporeal shock wave lithotripsy (ESWL) treatment of cholelithiasis

Abstract

Several treatments have recently been introduced for the treatment of cholelithiasis. Definitive indications for each of these modalities should be established. Our flow-chart illustrates the indications for extracorporeal shock wave lithotripsy (ESWL) treatment for gallbladder stones.
A stone is first examined ultrasonographically. Cholesterol stones (type I a acco r d ing to Tsutsiya's classification) are the stones suitable for ESWL while pigmented stones (type III) are generally not. For other types of stones ( Ib, Ic, II), radiography is indicated and calcified stones are excluded from the candidates of ESWL. If a stone does not appear to be calcified on X-ray films, a CT scan should be obtained whenever possible. Evidence of calcification on the CT scan indicates that the stone is rather unsuitable for ESWL. In contrast, an uncalcified stone is likely to be responsive to ESWL treatment.