PubMed · 6401042
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K Dvorák. 1983. [Cholelithiasis].. https://pubmed.ncbi.nlm.nih.gov/6401042/
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Too much clinical practice is based on unproved opinion. Health technology assessment (HTA) encourages critical review of the literature in a particular area, from which an objective assessment can be made so that clinical practice may be more scientifically based. Only a small number of centers undertake this type of work, usually at a national level. We have been able to set up a more local HTA system (the Wessex Development and Evaluation Committee) with links to clinicians and both providers and purchasers of health care within a region of 3 million people. All aspects of medicine may be reviewed and discussed by the committee; 3 examples from within the field of gastroenterology are summarized herein. Active participation of a university-based institute to provide the reviews is essential. A local HTA facility confers a number of advantages.
Lately, nonoperative treatment is being used in high risk patients with gallbladder or bile duct stones. Procedures include oral dissolution, extracorporeal shock wave lithotripsy, mechanical lithotripsy, contact dissolution or extraction after papillotomy or via a T-tube tract. We review nonsurgical treatment of gallstones and present our experience in the treatment of 9 patients using combinations of the above-mentioned modalities.
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