Lithotripsy for bile duct stones

Haemobilia

“…Stenting of biliary strictures is associated with haemobilia in up to 10 per cent of procedures 22,130,131 and may be dramatic 132 . Lithotripsy, whether endoscopic or extracorporal, is associated with an incidence of haemobilia of up to 10 per cent 37,93,133,134 . Perhaps surprisingly, the reported incidence of haemobilia does not necessarily rise when lithotripsy is combined with stenting for hepatolithiasis 24,135 .…”

Mechanical lithotripsy of large common bile duct stones

“…Extracorporeal shock-wave lithotripsy, once limited to gallblad- 26,27 Electrohydraulic lithotripsy (using high-pressure shock waves generated by a highvoltage discharge), has been used in conjunction with endoscopic techniques to fragment biliary calculi. 28 Pulsed-dye laser lithotripsy is a promising new adjunct for the endoscopic removal of biliary calculi too large for conventional lithotripsy techniques.…”

Extracorporeal Shock Wave Lithotripsy

“…Calcium content (nidus or rim) is a minor determinant compared with stone volume.5 Exceeding the size and composition recommendations often contributes to the relatively high (46%) retreatment rates associated with biliary ESWL. 28,32 Commonly encountered complications of biliary ESWL include biliary colic (23%), pancreatitis {1%), petechiae, and cardiac arrhythmia.28-3°,33 Often the lithotripter's firing sequence is controlled by an ECG signal (which triggers the device during the refractory period of the cardiac cycle) to decrease the risk of cardiac arrhythmias.…”