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All stools passed on the first 3 days after extracorporeal shock-wave lithotripsy of gallbladder stones in 21 patients were collected and examined for the presence of stone fragments. A total of 555 fragments varying in number per patient (4–69) and in size (maximum diameters from 0.5–8.0 mm) were recovered by sieving aqueous suspensions of the feces. All 482 fragments <-3.0 mm left the biliary tract without any clinical symptoms, as did the three largest fragments with maximum diameters of 7.0–8.0 mm and almost all of the 70 fragments measuring 3.5–5.0 mm. During the observation period, four episodes of biliary complaints were recorded in three patients in whom fragments with maximum diameters of 3.5–5.0 mm were found. The only chemical abnormality was a temporary elevation of lipase activity to twice the normal range in 1 case. All fragments were identified as gallbladder stones by infrared spectroscopy on the basis of their (varyingly high) cholesterol content. By macroscopic criteria, most of the fragments were from mixed stones; therefore, provided there is a functioning gallbladder and sufficiently fine fragmentation, successful extracorporeal shock-wave lithotripsy does not seem to be limited to pure cholesterol stones.

Extracorporeal shock wave lithotripsy (ESWL) and endoscopic sphincterotomy (EST) was performed in 35 patients suffering from pancreatic duct stones. Calculi disintegration and resolution of obstruction were achieved in all cases. Completely stone-free ducts were achieved in 16 patients (46%) while some peripheral asymptomatic stone material remained in 19 (54%). Dilation of the main pancreatic duct was reduced in 29 patients (83%). Twelve patients (34%) became completely asymptomatic and 17 (49%) reported a marked reduction of pain. Pancreatogenic steatorrhea ceased and 18 patients (51%) gained weight. Pathological glucose tolerance returned to normal in one patient. No major complications were observed. The combination of ESWL and EST is a successful, nonoperative, new treatment in pancreatic stone disease.