Fragmentation of bile duct stones by extracorporeal shock-wave lithotripsy: A five-year experience

Abstract

Over 5 yr, 103 elderly patients (mean age = 70 yr) with bile duct stones (mainly not amenable to endoscopic extraction) underwent adjuvant extracorporeal shock-wave lithotripsy using a first-generation kidney lithotripter. Disintegration of stones was achieved after a mean of 1.4 sessions in 92% of the patients. Spontaneous passage of fragments into the duodenum occurred in one fourth of the patients, and endoscopic extraction of fragments was necessary in 75% of the patients, resulting in complete clearance of the bile duct stones in 91 (88%) of 103 patients. The most important adverse effect was septic disease after extracorporeal shock-wave lithotripsy in 4% of the patients. The 30-day mortality rate was 1% (one patient), and another 15 patients died during a mean follow-up of 26 +/- 14 mo (mainly of causes unrelated to biliary tract disease). Two of 91 patients who had been rendered stone free were readmitted because of recurrent stone disease during the follow-up period. Of the 43 patients who still had their gallbladders during extracorporeal shock-wave lithotripsy, 14% subsequently underwent cholecystectomy. These data show that extracorporeal shock-wave lithotripsy of bile duct stones is a useful and safe adjunct to nonsurgical procedures for the removal of calculi in the biliary tree.

Effectiveness of extracorporeal shock wave lithotripsy on intrahepatic biliary calculi developing after choledochal cyst surgery: A case report

“…It was first used to treat bile duct stones in 1985, after its success and safety in treating renal calculi had been well established (9,10). Sauerbruch et al (9) demonstrated the efficacy of ESWL in achieving Common Bile Duct, stone disintegration in more than 90% of patients with minimal side effects. Okada et al (4) reported excellent results using this method for intrahepatic bile duct stone after choledochal cyst resection, and to the best of our knowledge, this was the first report showing the effectiveness of ESWL on biliary stones after choledochal cyst surgery.…”

Die akute Gallenkolik

“…Ist die Extraktion eines großen Konkrementes nach Papillotomie nicht mög-lich, kann bei zusätzlichem Einsatz verschiedener Lithotripsiemethoden (spezielle Lithotripterkörbchen,intrakorporale elektrohydraulische oder Laserlithotripsie, extrakorporale Stoßwellenlithotrip-sie) eine Sanierung der Gallengänge in 95% der Fälle erreicht werden [86,87,88] scher (oder offener) Cholezystektomie ("therapeutisches Splitting") das favorisierte Verfahren [89].…”

Endoskopische Therapie der Choledocholithiasis

“…ein weiteres Lithotripsieverfahren eingesetzt werden. Die perkutane extrakorporale Stoßwellenlithotripsie (ESWL) wird seit Mitte der 80er Jahre zur Behandlung der therapierefraktären Choledocholithiasis angewendet [24][25][26]. Sie ermöglicht ohne direkten Steinkontakt unter radiologischer oder sonographischer Ortung Behandlungen mit gutem Desintegrationsergebnis.…”