Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

Abstract

Background-Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath. Aims-To investigate the eVectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy. Methods-Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography. Results-Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously. Conclusion-Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed. (Gut 2000;47:728-731)

Evidence-based clinical practice guidelines for cholelithiasis 2016

“…Most reports have described the use of ESWL in conjunction with endoscopic transpapillary treatment or with PTCS therapy [187][188][189]. The purpose of ESWL is to break the stone into smaller fragments, thereby enabling its endoscopic removal.…”

“…Thus, in the event of intrahepatic bile duct stenosis, the stone is assumed not to be completely removed even after successful fragmentation, and indications for ESWL should be determined with care. During ESWL, it is often difficult to focus the shock waves on gallstones, and the target is usually located by injection of contrast medium via an ENBD tube or a PTBD tube [187,188].…”

“…ESWL was reported to be effective in the fragmentation of stones in 60-90% of cases, and the complete stone removal rate was 60-100% with concurrent treatment [187,188]. The level of fragmentation achieved by ESWL differed depending on the type of stone and was reported to be high (92%) for cholesterol stones and low (36%) for calcium bilirubinate stones.…”

Manejo del cálculo difícil en la vía biliar: Serie de casos

“…La litotripsia con ondas de choque extracorpórea (LOCE) puede ser utilizada sin importar el tamaño del cálculo y puede ser de ayuda en pacientes con anormalidades anatómicas como aquellos con cirugías Billroth II o Y de Roux. Los estudios con LOCE para el manejo del cálculo difícil han mostrado una tasa de éxito de 73% a 96% en la fragmentación y remoción completa de los cálculos (16)(17)(18)(19)(20)(21)(22)(23).…”

Endoskopische Therapie der Choledocholithiasis

“…Mit Geräten der 3. Generation wird heute Steinfreiheit bei mehr als 80% aller behandelten Patienten bei geringer methodenbedingter Komplikationsrate erzielt [27]. Die ESWL hat den Nachteil hoher Geräteanschaffungskosten und einer längeren Therapiedauer.…”