I could hardly move with pain, but shockwaves shattered my gallstones
00:53 GMT, 4 September 2012
00:53 GMT, 4 September 2012
Gallstones are becoming increasingly common — a quarter of women over 60 will develop them.
Here, Rosemary Randall, 67, from Whitchurch, Shropshire, tells about a new procedure she had to shatter the stones using shockwaves
'I couldn't keep food down,' said Rosemary Randall
Two years ago, I started getting frequent pains in my stomach and back.
I’d be doing the gardening or be out shopping and I’d have to stop and lie down to make it bearable.
Eventually it would go, but it often took a few hours to ease.
I put it down to indigestion, but within a few months it got more painful.
I hate going to the doctors, so I just thought I’d put up with it.
My husband, Malcolm, was a great support, but it was stopping me enjoying life.
Our daughter, Louise, lives in Surrey with her husband and our two teenage grandchildren, but I hardly dared make the trip there only to end up in pain.
Then, last October, two years after my symptoms had started, my skin started to change colour — I was going yellow.
I could hardly move with the pain and couldn’t keep food down. I knew I had to see my GP.
He sent me to hospital straight away, where I was sedated so they could do an endoscopy, where they put a tube with a tiny camera on the end of it down my throat. I had an ultrasound scan, too.
The doctors said the problem was gallstones — I had loads of them.
They explained that they are made of cholesterol and salts that form in the gallbladder, a little pear-shaped organ underneath the liver.
You can live with gallstones with no symptoms, but if they start to block the gallbladder they cause pain and nausea.
They can also stop the flow of bile out of the gallbladder and liver, so it backs up — that’s why I’d become jaundiced.
I was told gallstones were common, but a fatty diet can raise the risk, as they contain large quantities of cholesterol. I did eat a lot of dairy foods.
The doctors said the gallstones had to come out, because they can cause infection which can be fatal.
Under sedation I had a procedure where they put an endoscope down my throat and then put tiny baskets down the endoscope to remove the gallstones.
But there was one stone that was too big to get out — it was an inch wide and was stuck in a bile duct.
I had to have a tiny tube put into the bile duct to allow the bile to drain, otherwise I’d continue getting ill and you can even die from this.
I was in hospital for a few days while they sorted me out as best they could.
I was very worried. Then doctors told me that a new procedure was being carried out at Aintree University Hospital in Liverpool on the NHS.
Doctors would break up the gallstone into tiny bits using a probe that fires shock waves of energy, and then it could be removed bit by bit.
So, at the end of January, I went to Liverpool. I was given a general anaesthetic and was in theatre first thing in the morning. The procedure took 90 minutes.
When I came to I felt fine — it was the first time in years I’d not had any sort of discomfort, sickness or pain. I went home at 5pm.
Since then I’ve been able to go back to gardening and walking the dog, and seeing my daughter and grandchildren, and I make sure I eat healthily.
I’m so happy to be feeling good again — this procedure changed my life.
Dr Richard Sturgess is a gastroenterologist at Aintree University Hospital, Liverpool. He says:
By the age of 60 nearly a quarter of women will have developed gallstones
One in ten women and one in 20 to 30 men aged between 40 and 60 have gallstones.
By the age of 60 nearly a quarter of women will have developed gallstones, but we’re not sure why women are more likely to develop them.
In most cases, they do not cause symptoms. But one in 50 sufferers have pain and nausea.
The risk increases with age, because of the time it takes a gallstone to build up.
But we’re seeing an increasing number of younger people with the condition because a fatty, high-cholesterol diet makes you more vulnerable.
Gallstones form from a build-up of cholesterol in the gallbladder or its surrounding bile ducts.
These ducts are tiny tubes that carry bile — a liquid that helps the body digest fats — from the liver to the gallbladder and then into the digestive system.
The most widely used treatment is surgery to remove the gallbladder.
People can lead normal lives without a gallbladder as the liver still produces bile to digest food.
Around 10 per cent of patients also have gallstones in the bile ducts and in this case, we will perform an endoscopic retrograde cholangiopancreatography (ERCP).
Here, an endoscope is passed into the mouth and to the stomach where the bile ducts are. A fine tube is passed through the endoscope into the bile duct, and then the bile is injected with a dye to show any blockages.
We make a 1cm cut at the opening of the bile duct, and then pass tiny baskets made of flexible metal down the endoscope to catch the gallstones.
We may also insert and then inflate tiny balloons, to widen the bile duct.
However, around 10 to 20 per cent of gallstones can’t be removed with this technique, because they are too big or the bile duct is too narrow.
Up until now, the only thing that could be done for these patients would be to place a tiny internal drain into the duct to keep the bile flowing — but the drains can get blocked, causing infection, so they have to be replaced every three months.
But a new procedure — ERCP plus cholangioscopy — was developed in the U.S. six years ago.
It’s challenging to perform and requires lots of training, so it has only recently become readily available in Britain.
The equipment we use for it is called SpyGlass, which consists of a ‘baby endoscope’ that can pass through a standard endoscope and then into the bile duct to see abnormalities.
We pass a tiny probe, less than a millimetre in width, down the endoscope.
The probe — known as an electro-hydraulic lithotripter — emits electro-hydraulic shock waves that shatter the gallstones with bursts of energy from the probe.
The camera on the endoscope allows us to see the gallstone shattering.
We keep firing at it until we can see it’s small enough to drag away using ERCP.
The procedure can be performed as a day case.
As with the conventional ERCP procedure it carries a 10 per cent risk of complications, including pancreatitis, bleeding, infection and perforation of the gut, but these are readily treated.
The gallstone clearance rate is more than 80 per cent.
The procedure, also available at eight other NHS hospitals, costs 3,000 to 5,000 to the NHS, depending on the complexity. It can also be carried out privately.
For details on gallstones, visit corecharity.org.uk