Fatal long-term consequence of an allegedly safe and promising procedure: case report of gallbladder cancer 22 years after extracorporeal shockwave lithotripsy for gallstones
Background: Extracorporeal shockwave lithotripsy (ESWL) was first introduced in 1985 as a noninvasive, promising treatment option for gallbladder stones and extensively used especially in central European countries the following years. Due to high stone recurrence rates with secondarily indicated cholecystectomy and the introduction of laparoscopic surgery, ESWL gradually disappeared and is nowadays only rarely performed. In new techniques, long-term issues are sometimes not recognized initially.
Methods: We present a case of gallbladder cancer 22 years after ESWL in a 46-year-old female patient with fatal outcome. A short review on the history and technique of ESWL is presented and a possible relation to gallbladder cancer is discussed.
Results: Although gallbladder cancer after other gallbladder-preserving treatments for cholecystolithiasis‒such as cholecystostomy‒is a well-described issue, the present case is the only published report after ESWL in the English literature.
In our patient, gallbladder cancer is probably not a direct cause of ESWL shock waves. Most likely chronic inflammation due to recurrent stones caused cancer. The fatal course of this case could have been prevented if regular follow-up and cholecystectomy would have been performed earlier.
Conclusions: Thousands of patients were treated with ESWL for gallbladder stones in the 1980s. Stone recurrence rates are high, but late complications such as malignancy are rare. On the other hand, since many patients were treated at a young age, regular long-term follow-up should be discussed in this cohort. We aim to draw attention to this topic and possibly prevent further cases.