Extracorporeal shock wave treatment of common bile duct stones: Experience with two different lithotriptors at a single institution

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is a new treatment modality for retained common bile duct stones. Sixty-two patients (mean age 75 years, range 27-95 years) with retained common bile duct stones were treated with two different lithotriptors. One of the lithotriptors operated on the electrohydraulic principle (Dornier HM-3) (n = 13), the other on the electromagnetic principle (Siemens Lithostar) (n = 49). All HM-3 patients were treated under general anaesthesia, whereas with the Lithostar one patients was treated under general anaesthesia, 43 received analgesia and sedation and five had no analgesia at all. Patients treated with the Lithostar had more sessions (mean 1.9 versus 1.3, P less than 0.05) and needed more stock waves (mean 8611 versus 2534, P less than 0.001) than patients treated with the HM-3. Fragmentation was achieved in all patients treated with the HM-3 and in 42 (86 per cent) patients treated with the Lithostar. In this latter group ten patients underwent common bile duct exploration without complications. Eleven patients had transient haematuria after treatment with the HM-3 and two patients (one in each group) had a subcapsular haematoma of the right kidney, all without clinical sequelae. At follow-up (median: HM-3 43 months, Lithostar 18 months), none of the patients had biliary complaints. We conclude that ESWL of retained common bile duct stones in safe and effective with both lithotriptors and should be considered before surgery in the elderly or high-risk patient.

Italian consensus guidelines for chronic pancreatitis

“…ESWL overcomes the problem of the stone size by fragmenting the stones, thus facilitating endoscopic clearance of the duct. ESWL is required in 36−68% of patients and successful rates of stone clearance of the main pancreatic duct ranged from 37% to 100% [115,120,173,[179][180][181][182][183][184][185][186][187]. Use of ultrasound instead of x-rays to locate pancreatic stones is associated with a lower fragmentation rate [188,189].…”

Extracorporeal shock wave lithotripsy for difficult common bile duct stones: a comparison between 2 different lithotripters in a large cohort of patients

“…13 To date, almost all published studies comparing different models of lithotripters have focused on the clearance rates of urologic stones, and studies comparing the efficacy of different lithotripters in the management of biliary stones are lacking. [14][15][16][17][18][19][20][21][22][23][24] The aim of our study was to compare the CBD clearance rates achieved after ESWL performed with 2 different models of electromagnetic lithotripters in a large cohort of patients with difficult CBD stones.…”

Role of extracorporeal shock wave lithotripsy in hepato‐biliary‐pancreatic surgery

“…The morbidity rate of ESWL of common bile duct stones is low: Macrohematuria (in 2-11% of the patients) and hemobilia (2-8%) are reported to resolve within a few days [8,18,20]. Septic fever in 3% to 6% of the cases is often regarded as an exacerbation of already existing cholangitis [8,18,19]. There has not been any ESWL-related mortality, but mortality associated with the adjuvant endoscopic or percutaneous procedures, which is about 1% [36,39], must be borne in mind.…”

“…ESWL of pancreatic stones in chronic calcifying pancreatitis is still relatively unknown but seems effective [22]. The morbidity and mortality associated with ESWL are minimal [7,8,[11][12][13][18][19][20][21][22] and compare favorably to those with surgery. Therefore we have tried to assess the exact role of ESWL in this field with our own prospectively followed patients and other patient series.…”

“…Rigid entry criteria, expensive adjuvant dissolution therapy, moderate results, and the possibility of stone recurrence after gallbladder-preserving therapies are major drawbacks [7,[10][11][12][13][14][15][16][17]. ESWL of common bile duct stones is useful in patients in whom endoscopic removal proves impossible [8,[18][19][20][21]. ESWL of pancreatic stones in chronic calcifying pancreatitis is still relatively unknown but seems effective [22].…”