TREATMENT ALGORITHM

Now, I'd like to take your attention again. This is the same algorithm published in our alphabet, in our gastroenterology book in Sleisenger. The algorithm hasn't been used in the United States yet. Hopefully, after our study is finished and we get the CPT code and we're going to use the system, we can use this algorithm accordingly. According to this algorithm, like what we do here, we see the gallstones, if they have a biliary colic ¾ let's assume first, if they don't have a biliary colic, we watch this patient. Supposedly. In real life I don't know how it works, but if the patients don't have any symptoms, they don't need any modalities and we will watch these patients. But if they have a pain, any complications, like cystitis and others, those patients might need a cholecystectomy, ideally lap. cholecystectomy. If the patient is in pain but has no complications, no acute cholecystitis, no acute pancreatitis or this type of thing, patients normal function and gallbladder, and if they have a non-calcified stone, small stone less than 5 to 20 millimeters (4 to 20 mm is FDA protocol), might go with the dissolution therapy. It's the long way to do it but it is done in the United States. This option was given to our patients in Europe. In the United States we are a little bit more aggressive and I think we like to do things as soon as possible. The managed care system is pushing us in this regard, also, but nevertheless, this is one of the options patients might have. And the patients with the single stone 5 to 20 millimeters (4 to 20 mm is FDA protocol), acceptable option is extra corporeal shock wave lithotripsy. So I hope in the short run we might go and be able to use this type of algorithm in our patients.