Refik Mas

Evaluation of hepatocyte function after extracorporeal shock wave lithotripsy with hepatobiliary scintigraphy

Objective: Extra corporeal shock wave lithotripsy is a promising and effective therapy mode in the nonsurgical therapy of gallstones. This prospective study was conducted to investigate the effects of ESWL on hepatocellular function, using quantitative hepatobiliary scintigraphy, serum aminotransferase, alkaline phosphatase (ALP), amylase (AML), and direct and indirect bilirubin levels. Methods: The study consisted of 22 patients with ultrasonographically documented gallstones. Hepatobiliary scintigraphy was applied to all patients before ESWL and biochemical tests were performed. Scintigraphy and biochemical tests were repeated in 16 patients 24 h, in seven patients 72 h, and in six patients 1 wk after ESWL. The hepatic extraction fraction (HEF) was calculated using deconvolution analysis of scintigraphic data. Results: All patients’ pre-ESWL biochemical tests and HEF values were within the normal range. The 24- and 72-h post-ESWL aminotransferase, ALP, and AML levels and HEF values were significantly different from pre-ESWL values (p < 0.05). After 1 wk this difference disappeared. Decreased HEF values were observed in 50% of patients 24 h, in 71.7% of patients 72 h, and in 16.6% of patients 1 wk after ESWL. A direct relationship was also observed between the number of shocks applied and the degree of impairment in HEF values. Conclusion: Transient hepatocellular dysfunction, which usually occurs after ESWL, can be demonstrated and monitored using quantitative hepatobiliary scintigraphy.