Principles of Extracorporeal Shockwave Lithotripsy (ESWL)

Napier-Hemy, Richard; Payne, Steve

doi:10.1007/978-1-4471-2422-1_69

Cited by 1 publication

(4 citation statements)

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“…Shock wave generators use electrohydraulic, piezoelectric, or electromagnetic technology to generate shock waves. 11 Lithotripters have a focusing mechanism to concentrate energy onto the stone and thus reduce any damaging effects on the surrounding tissue. 8 , 10 Externally generated shock waves require transmission into the patient by a medium.…”

Section: Technology Under Reviewmentioning

confidence: 99%

“…In newer systems, coupling is achieved by the use of water-filled cushions brought into contact with the skin using a gel. 1 , 11 …”

Section: Technology Under Reviewmentioning

confidence: 99%

“…Accurate targeting of the shock waves on the stone is essential for effective lithotripsy and is achieved by use of an imaging modality. 11 , 12 , 13 Fluoroscopy and US have been used for this purpose. Because fluoroscopy can detect only radiopaque stones, an intraductal stent may be placed to allow focusing of shock waves along the duct to target additional radiolucent stones.…”

Section: Technology Under Reviewmentioning

confidence: 99%

“…Several large case series have demonstrated that mechanical lithotripsy (ML) leads to complete bile duct clearance in about 80% to 90% of patients; however, 20% to 30% of patients require more than 1 procedure. 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ML is less likely to be successful with larger and impacted stones. 21 , 24 In a series of 209 patients with a median stone diameter of 18 mm, the rate of successful stone clearance fell from 87.6% to 67.6% for stones >25 mm.…”

Section: Efficacy and Comparative Studiesmentioning

confidence: 99%

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Biliary and pancreatic lithotripsy devices

Watson¹,

Parsi²,

Aslanian³

et al. 2018

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Background and AimsLithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL).MethodsIn this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations.ResultsAlthough many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs.ConclusionsSeveral lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones.

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Section: Technology Under Reviewmentioning

confidence: 99%

“…In newer systems, coupling is achieved by the use of water-filled cushions brought into contact with the skin using a gel. 1 , 11 …”

Section: Technology Under Reviewmentioning

confidence: 99%