Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Abstract

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n=4) or huge common bile duct stones (n=29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800 -7500 discharges, which were applied during one (n=21), two (n =6) or three sessions (n=6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were observed for a total of 51 procedures. We believe electromagnetically generated shock waves are safe, easy to apply, and relatively effective in the therapy of common bile duct and intrahepatic stones. too risky to be performed in a municipal hospital.Typical problems were intrahepatic calculi (four), large or impacted bile duct stones, bile duct stenosis with concrements proximal to the stenosis, patients with juxtapapillary diverticulum or previous Billroth-II-resection of the stomach. Out of a total of 174 patients (Table)

Multidisciplinary Conservative Treatment of Difficult Bile Duct Stones: A Real Alternative to Surgery

“…There was no case of cholangitis, particularly dangerous in this kind of pathology, probably thanks to the drainage placed in the biliary tract in almost all cases and to antibiotic treatment during the process of clearing. In our series, there was no evidence of major complications, as has, instead, been described by some other groups [20][21][22] …”

“…There was no case of cholangitis, particularly dangerous in this kind of pathology, probably thanks to the drainage placed in the biliary tract in almost all cases and to antibiotic treatment during the process of clearing. In our series, there was no evidence of major complications, as has, instead, been described by some other groups [20][21][22] In conclusion, the choice between surgical and non-invasive removal of stones should in our point of view be made individually for each patient, taking into consideration the risk for surgery for that patient but also, in patients without surgical risk, the fact that fortheirbiliary patology they had already been submitted to previous multiple surgical interventions. The presence of very large stones (>35 mm), the only ones not cleared in our experience, could militate against non-surgical approach.…”

Non-Surgical Approaches to Stones in the Biliary Tree

“…Second generation extracorporeal shock wave lithotriptors. which generate shock waves by either spark gap, piezo-electric crystals or an electromagnetic coil, do not require the use of a water bath or a general anaesthetic [74,75]. With these new techniques for generation of shock waves, it is possible to apply it relatively effectively for common bile duct and intrahepatic stones, although the experience is limited to a few specialist centres [75,76], Staritz et al [75] have treated 33 patients.…”

“…which generate shock waves by either spark gap, piezo-electric crystals or an electromagnetic coil, do not require the use of a water bath or a general anaesthetic [74,75]. With these new techniques for generation of shock waves, it is possible to apply it relatively effectively for common bile duct and intrahepatic stones, although the experience is limited to a few specialist centres [75,76], Staritz et al [75] have treated 33 patients. Stone clearance was achieved in 70% of cases [75], while Sauerbruch et al [76] conducted a controlled multicentre trial of 113 patients with bile duct stones with a success rate of 91 %.…”

“…With these new techniques for generation of shock waves, it is possible to apply it relatively effectively for common bile duct and intrahepatic stones, although the experience is limited to a few specialist centres [75,76], Staritz et al [75] have treated 33 patients. Stone clearance was achieved in 70% of cases [75], while Sauerbruch et al [76] conducted a controlled multicentre trial of 113 patients with bile duct stones with a success rate of 91 %. A recent study by Ponchon et al [77] using a pulsed dye laser of bile duct stones has also produced exciting results.…”