Gallstone Disease - Springer978-3-642-74619-2/1.pdf · Gallstone Disease Pathophysiology and...

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Page 1: Gallstone Disease - Springer978-3-642-74619-2/1.pdf · Gallstone Disease Pathophysiology and Therapeutic Approaches Editors w. Swobodnik, H. Ditschuneit, and R. D. Soloway With 99
Page 2: Gallstone Disease - Springer978-3-642-74619-2/1.pdf · Gallstone Disease Pathophysiology and Therapeutic Approaches Editors w. Swobodnik, H. Ditschuneit, and R. D. Soloway With 99

Gallstone Disease Pathophysiology and Therapeutic Approaches

Editors w. Swobodnik, H. Ditschuneit, and R. D. Soloway

With 99 Figures and 43 Tables

Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong

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Swobodnik, w. Abteilung Innere Medizin II, Gastroenterologie und Ernahrungswissenschaften, Univer­sitatsklinikum Ulm, Robert-Koch-StraBe 8, D-7900 Ulm, FRG

Soloway, R. D. Division of Gastroenterology, 4.106 McCullough, G-64, University of Texas Medical Branch at Galveston, Galveston TX 77550, USA

Ditschuneit, H. Abteilung Innere Medizin II, Gastroenterologie und Ernahrungswissenschaften, Univer­sitatsklinikum Ulm, Robert-Koch-StraBe 8, D-7900 Ulm, FRG

ISBN -13 :978-3-540-50965-3 e-ISBN -13 :978-3-642-74619-2 DOl: 10.1007/978-3-642-74619-2

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, reuse of illustrations, broadcasting, repro­duction by photocopying machine or similar means, and storage in data banks.

Under § 54 of the German Coypright Law, where copies are made for other than private use, a fee is payable to Verwertungsgesellschaft Wort, Munich.

© Springer-Verlag, Berlin Heidelberg 1990

Product Liability: The publisher can give no guarentee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

2127/3321-543210 - Printed on acid-free paper

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Preface

The nonsurgical management of gallstone disease has drawn widespread clinical interest during the last decade as ultrasound surveys have indicated that cholelithiasis is predom­inantly an asymptomatic condition and much more prevalent than previously thought. This book presents an overview of the pathophysiologic and pathobiochemical principles of gallstone formation and the consequences for clinical therapeutic regimens. New information concerning the balance between vesicular and micellar transport of choles­terol, early cholesterol nucleation, and the influence of inhibiting and promoting com­pounds for cholesterol nucleation as well as information concerning the effects of changes in gallbladder motility and gallbladder mucosal function is reviewed. In order to make further progress in developing treatments which facilitate gallstone dissolution and in preventing disease, it is necessary to integrate this new data into our thinking.

Methods of treatment such as systemic litholysis of cholesterol gallbladder stones with bile acid preparations and mechanical fragmentation of stones either by extracorpo­ral shock waves or intracorporal laser systems are carefully described and separate discussions of direct contact litholysis of cholesterol stones with ether preparations and the local litholytic treatment of calcified pigment stones are included. New therapeutic applications of HMG-CoA-reductase inhibitors and nonsteroidal anti-inflammatory drugs are also critically reviewed. Finally, for the interested reader an evaluation of prophylactic treatment against stone recurrence after successful conservative treatment and an appraisal of alternative management strategies supplement the information on the conservative treatment of gallstones.

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Contents

Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processses

Increased Biliary Lithogenicity Through Cholesterol Supersaturation M. C. Carey . . . . . . . . . . . . . . . . . . . . . . . . . 3

Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis G. Salvioli, R. Lugli, and M. Pellati . . . . . . . . . . . . . . . 11

Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems P. Fromherz. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27

Pigment Gallstones and Secondary Calcification of Gallstones R. D. Soloway, 1. G. Wu, and D. F. Xu . . . . . . . . . . 35

The Influence of the Gallbladder Epithelium on Gallstone Formation B. F. Smith . . . . . . . . . . . . . . . . . . . . . . . . . 47

Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors P. R. C. Harvey and S. M. Strasberg . . . . . . . . . . . . . . 55

Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin U. G. Kliippelberg, X. Molero, H. Y. Gaisano, and L. 1. Miller. . . . . . 67

Environmental Factors and Gallstones 1. G. Wechsler . . . . . . . . . . . . . . . . . .

Different Therapeutic Approaches to Gallstone Disease

Is Therapeutic Intervention Necessary in Gallstone Disease? The Surgeon's Point of View B.S. Ashby ................. .

Surgical Therapy for Acute Gallstone Complications W Oettinger, K. Orth, and B. Leibl ...... .

Therapeutic Interventions in Patients with Gallbladder Stones: The Internist's View G. Paumgartner .................... .

Acute Biliary Pancreatitis P. Malfertheiner . . . .

87

95

99

103

109

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VIIl

Systemic Litholysis with Bile Acids

Principles of Gallstone Dissolution with Chenodeoxycholic Acid, Ursodeoxycholic Acid, and the Combination of Both Bile Acids A. Stiehl ..................... .

Systemic Litholysis with Bile Acids: Ursodeoxycholic Acid W Kurtz ..................... .

Combination Therapy of Chenodeoxycholic Acid and Ursodeoxycholic Acid M. Podda, M. Zuin, M. L. Petroni, E. Bertolini, A. Crosignani,

Contents

115

121

and G. Grandinetti. . . . . . . . . . . . . . . . . . . . . . . . .. 127

Results of an Index-Controlled Combination Therapy with Ursodeoxycholic and Chenodeoxycholic Acid P. Janowitz, W Swobodnik, 1. G. Wechsler, S. Fischer, 1. Tudyka, and H. Ditschuneit . . . . ~ . . . . . . . . . . . . . . . . . . . . .. 135

Extracorporeal Schock- Wave-Lithotripsy

Physical Basis of Lithotriptors U. Faust ............. .

Extracorporeal Shock-Wave Lithotripsy of Gallstones G. Paumgartner, M. Sackmann, 1. Holl, and T. Sauerbruch

Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones M. Staritz, A. Rambow, A. Floth, P. Mildenberger, M. Goebel, T. Junginger,

147

161

R. Hohenfellner, M. Thelen, and K.-H. Meyer zum Biischenfelde . . . .. 165

Piezoelectric Lithotripsy of Gallbladder Stones C. Ell, W Kerze1, H. T. Schneider, W Domschke, and E. G. Hahn 171

Biliary Shock-Wave Lithotripsy: Experience of the First 3 Years in 612 Patients L. Greiner and C. Jakobeit . . . . . . . . . . . . . . . . . . . . . .. 177

Laser Lithotripsy

Laser Lithotripsy: Basic Physics R. Steiner and Th. Meier . . .

Laser Lithotripsy: Clinical Applications C. Ell, 1. Hochberger, E. G. Hahn, and L. Demling .

Local Litholysis

Local Litholytic Agents: Dissolution of Cholesterol Biliary Tract Stones with Methyl tert-Butyl Ether

195

201

1. L. Thistle, B. T. Petersen, 1. E. McCullough, C. E. Bender, and A.1. LeRoy. 205

Local Litholysis of Calcified Pigment Stones W Swobodnik . . . . . . . . . . . . . . . . . 211

Local Litholysis of Intrahepatic Calculi K. Draese, 1. Schopohl, C. E. Zockler, and S. Martin 217

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Contents IX

New Therapeutic Trends

Reduction of Biliary Cholesterol Saturation by Inhibition of Cholesterol Synthesis: New Therapeutic Consequences? K. von Bergmann, T. Heinemann, and D. Liitjohann . . . . . . . . . . .. 225

Gallstone Prevention by Alteration of Gallbladder Mucin Secretion via Prostaglandin Synthesis Inhibition B. F. Smith and J. T. LaMont .. . . . . . . . . . . . . . . . . . . .. 231

Gallstone Prevention After Successful Treatment R. H. Dowling . . . . . . . . . . . . . . . .

Intermittent Bile Acid Therapy as an Alternative Therapeutic Strategy T. C. Northfield and R. P. lazrawi

Subject Index . . . . . . . . .

237

239

249

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Contributors

Ashby, B.S. Department of Surgery, Southend Hospital, Prittlewell Chase, Southend, SSO ORY, U.K.

Bender, C. E. Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA

von Bergmann, K. Abteilung Klinische Pharmakologie, Medizinische Klinik, UniversiHit Bonn, Sigmund-Freud-StraBe 25, 5300 Bonn 1, FRG

Bertolini, E. Institute of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan, Italy

Carey, M.C. Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

Crosignani, A. Institute of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan. Italy

Demling, L. Medizinische Klinik I mit Poliklinik, UniversiHit Erlangen-Niirnberg, Krankenhaus­straBe 12, 8520 Erlangen, FRG

Ditschuneit. H. Abteilung Innere Medizin II, Gastroenterologie und Erniihrungswissenschaften, Universitiitsklinikum Ulm, Robert-Koch-StraBe 8, 7900 Ulm, FRG

Domschke, W. Medizinische Klinik I mit Poliklinik, Universitiit Erlangen-Niirnberg, Krankenhaus­straBe 12. 8520 Erlangen, FRG

Dowling, R. H. Gastroenterology Unit, Guy's Hospital, Guy's Tower, London SE1 9RT, UK

Draese, K. Chirurgische Klinik, Krankenhaus Bad Oeynhausen, WielandstraBe 28, 4970 Bad Oeynhausen, FRG

Ell, C. Medizinische Klinik I mit Poliklinik, Universitiit Erlangen-Niirnberg, Krankenhaus­straBe 12, 8250 Erlangen, FRG

Faust, U. Institut fUr Biomedizinische Technik der Universitiit Stuttgart, SeidenstraBe 36, 7000 Stuttgart 1, FRG

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XII Contributors

Fischer, S. Abteilung Innere Medizin II, Gastroenterologie und Erni.i.hrungswissenschaften, Universiti.i.tsklinikum Ulm, Robert-Koch-Stral3e 8, 7900 Ulm, FRG

Floth, A. Urologische Klinik, Universiti.i.t Mainz, Langenbeckstral3e 1, 6500 Mainz, FRG

Frenzel, F. Abteilung fUr Gastroenterologie, Ferdinand-Sauerbruch-Klinikum, Arrenberger Stral3e 20-56, 5600 Wuppertal1, FRG

Fromherz, P. Abteilung fUr Biophysik der Universiti.i.t Ulm, Oberer Eselsberg, 7900 Ulm, FRG

Gaisano, H. Y. Gastroenterology Research Unit., Mayo Clinic and Foundation, Rochester, MN 55905, USA

Goebel, M. Radiologische Klinik, Universiti.i.t Mainz, Langenbeckstral3e 1, 6500 Mainz, FRG

Grandinetti, G. Institute of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan, Italy

Greiner, L. Abteilung fur Gastroenterologie, Ferdinand-Sauerbruch-Klinikum, Arrenberger Stral3e 20-56,5600 Wuppertal1, FRG

Hahn, E.G. Medizinische Klinik I mit Poliklinik, Universiti.i.t Erlangen-Nurnberg, Krankenhaus­stral3e 12, 8520 Erlangen, FRG

Harvey, P. R. C. Department of Surgery and Research Institute, Mount Sinai Hospital, University of Toronto, 600 University Ave., Toronto, Ontario M5G 1X5, Canada

Heinemann, T. Abteilung Klinische Pharmakologie, Medizinische Klinik, Universiti.i.t Bonn, Sigmund-Freud-Stral3e 25,5300 Bonn 1, FRG

Hochberger, J. Medizinische Klinik I mit Poliklinik, Universiti.i.t Erlangen-Nurnberg, Krankenhaus­stral3e 12, 8520 Erlangen, FRG

Hohenfellner, R. Urologische Klinik, Universitat Mainz, Langenbeckstral3e 1, 6500 Mail1Z, FRG

Holl, J. Medizinische Klinik II, Universitat Munchen, Klinikum Grol3hadern, Marchionini­stral3e 15, 8000 Munchen 70, FRG

Jakobeit, C. Abteilung fur Gastroenterologie, Ferdinand-Sauerbruch-Klinikum, Arrenberger Stral3e 20-56, 5600 Wuppertal 1, FRG

Janowitz, P. Abteilung Innere Medizin II, Gastroenterologie und Erni.i.hrungswissenschaften, Universitatsklinikum Ulm, Robert-Koch-Stral3e 8, 7900 Ulm, FRG

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Contributors

Jazrawi, R. P. Department of Biochemical Medicine, St. George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK

Junginger, T. Chirurgische Klinik, Universitiit Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

Kerzel, M.

XIII

Medizinische Klinik I mit Poliklinik, Universitiit Erlangen-Niirnberg, Krankenhaus­straBe 12, 8520 Erlangen, FRG

Kliippelberg, U. G. Gastroenterology Research Unit, Mayo Clinic and Foundation, Rochester, MN 55905, USA (present address: Innere Medizin II, Klinikum GroBhadern der Universitiit Miinchen, MarchioninistraBe 15, 8000 Miinchen 70, FRG)

Kurz, W Medizinische Klinik 1, Zentralkrankenhaus Reinkenheide, PostbrookstraBe, 2850 Bremerhaven, FRG

LaMont, J. T. Section of Gastroenterology, University Hospital, Boston University Medical Center, Boston, MA 02118, USA

Leibl, B. Abteilung fUr Allgemeine Chirurgie, Universitiit Ulm, SteinhovelstraBe 9, 7900 Ulm, FRG

LeRoy, A.J. Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA

Lugli, R. Patologia Speciale Medica, Universita di Modena, Viale Vittorio Veneto 9, 41100 Modena, Italy

Liitjohann, D. Abteilung Klinische Pharmakologie, Medizinische Klinik, Universitiit Bonn, Sigmund-Freud-StraBe 25, 5300 Bonn 1, FRG

Malfertheiner, P. Abteilung Innere Medizin II, Universitiit UIm, Robert-Koch-StraBe 8, 7900 Ulm, FRG

Martin, S. Chirurgische Klinik, Krankenhaus Bad Oeynhausen, WielandstraBe 28, 4970 Bad Oeynhausen, FRG

McCullough, J. E. Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA

Meier, T. Institut fUr Lasertechnologien in der Medizin, Universitiit Ulm, HelmholtzstraBe 12, 7900 Ulm, FRG

Merz, B. Abteilung fUr Gastroenterologie, Ferdinand-Sauerbruch-Klinikum, Arrenberger StraBe 20-56, 5600 Wuppertall, FRG

Meyer zum Biischenfelde, K.-H. I. Medizinische Klinik und Poliklinik, Universitiit Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

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XIV Contributors

Mildenberger, P. Radiologische Klinik, Universitat Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

Miller, L. 1. Gastroenterology Research Unit, Mayo Clinic and Foundation, Rochester, MN 55905, USA

Molero, x. Gastroenterology Research Unit, Mayo Clinic and Foundation, Rochester, MN 55905, USA

Northfield, T. C. Department of Biochemical Medicine, St. George's Hospital Medical School, Cran­mer Terrace, London SW17 ORE, UK

Oettinger, W. Abteilung fUr Allgemeine Chirurgie, Universitat Ulm, SteinhovelstraBe 9, 7900 Ulm, FRG

Orth, K. Abteilung fUr Allgemeine Chirurgie, Universitat Ulm, SteinhovelstraBe 9, 7900 Ulm, FRG

Paumgartner, G. Medizinische Klinik II, Universitat Munchen, Klinikum GroBhadern, Marchionini­straBe 15, 8000 Munchen 70, FRG

Pellati, M. Patologia Speciale Medica, Universita di Modena, Viale Vittorio Veneto 9, 41100 Modena, Italy

Petersen, B. T. Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA

Petroni, M. L. Institute of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan, Italy

Podda, M. Chair of Internal Medicine, University of Milan, Via A. di Rudini 8, 20142 Milan, Italy

Rambow, A. I. Medizinische Klinik und Poliklinik, Universitat Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

Sackmann, M. Medizinische Klinik II, Universitat Munchen, Klinikum GroBhadern, Marchionini­straBe 15, 8000 Munchen 70, FRG

Salvioli, G. Patologia Speciale Medica, Universita di Modena, Viale Vittorio Veneto 9, 41100 Modena, Italy

Sauerbruch, T. Medizinische Klinik II, Universitat Munchen, Klinikum GroBhaderm. Marchionini­straBe 15, 8000 Munchen 70, FRG

Schneider, H. T. Medizinische Klinik I mit Poliklinik, Universitat Erlangen-Nurnberg, Krankenhaus­straBe 12, 8520 Erlangen, FRG

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Contributors

Schopohl, J. Chirurgische Klinik, Krankenhaus Bad Oeynhausen, WielandstraBe 28, 4970 Bad Oeynhausen, FRG

Smith, B. F.

xv

Section of Gastroenterology and Hepatology, Boston City Hospital, Boston Univer­sity Medical Center, 818 Harrison Avenue, Boston. MA 021118, USA

Soloway, R. D. Division of Gastroenterology, 4.106 McCullough, G-64, University of Texas Medical Branch at Galveston, Galveston TX 77550, USA

Staritz, M. I. Medizinische Klinik und Poliklinik, Universitat Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

Steiner, R. Institut fUr Lasertechnologien in der Medizin, Universitat Ulm, HelmholtzstraBe 12, 7900 Ulm, FRG

Stiehl, A. Medizinische Klinik, Klinikum der Universitat Heidelberg, Bergheimer StraBe 58, 6900 Heidelberg 1, FRG

Strasberg, S. M. Department of Surgery and Research Institute, Mount Sinai Hospital, University of Toronto, 600 University Ave., Toronto, Ontario M5G 1X5, Canada

Swobodnik, W. Abteilung Innere Medizin II, Gastroenterologie und Ernahrungswissenschaften, Uni­versitatsklinikum Ulm, Robert-Koch-StraBe 8, 7900 Ulm, FRG

Thelen, M. Radiologische Klinik, Universitat Mainz, LangenbeckstraBe 1, 6500 Mainz, FRG

Thistle, J. L. Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA

Tudyka, J. Abteilung Innere Medizin II, Gastroenterologie und Ernahrungswissenschaften, Uni­versitatsklinikum Ulm, Robert-Koch-StraBe 8, 7900 Ulm, FRG

Wechsler, J. G. Abteilung Innere Medizin II, Gastroenterologie und Ernahrungswissenschaften, Uni­versitatsklinikum Ulm, Robert-Koch-StraBe 8, 7900 Ulm, FRG

Wenzel, H. Abteilung fUr Gastroenterologie, Ferdinand-Sauerbruch-Klinikum, Arrenberger StraBe 20-56, 5600 Wuppertal1, FRG

Wu,J.G. Department of Chemistry, Beijing University, Beijing 100871, People's Republic of China

Xu, D.F. Section of Polymer Chemistry, Sinica Academica, Beijing 100871, People's Republic of China

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XVI Con tri butors

Z6ckler, C. E. Chirurgische Klinik, Krankenhaus Bad Oeynhausen, Wielandstra13e 28, 4970 Bad Oeynhausen, FRG

Zuin, M. Institute of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan, Italy