Transcholecystic Endoscopic Choledocholithotripsy: Successful Management of Retained Common Bile Duct Stone

Abstract

Removal of large common bile duct stones has been a continuing challenge. The feasibility and efficacy of transcholecystic endoscopic choledocholithotripsy in a high-risk patient are demonstrated in this report. The procedure requires an established cholecystostomy track, catheter dilatation of the cystic duct, and the application of electrohydraulic shock waves to the calculus. The use of a choledochofiberscope permits the passage of the electrohydraulic probe and minimizes complications by direct monitoring. Stone fragments are removed by basket retrieval. This procedure in conjunction with minicholecystostomy may obviate the need for surgery in selected high-risk patients with combined gallbladder and common bile duct stones.

Retained bile duct stones in a patient with Billroth II gastrectomy: extracorporeal shock wave lithotripsy and papillary dilatation via T tube.

“…Larger stones require fragmentation, which can be achieved either mechanically with a basket5 or by local application of shock waves. 6 Meanwhile, reports using ESWL on bile duct stones with electrohydraulically,7 electromagnetically,8 and piezoelectrically9 generated shock waves have been published. Johlin treated large retained stones with ESWL and extracted the remaining fragments either through the T tube channel or via endoscopic sphincterotomy.…”

Die percutane transhepatische Laserlithotripsie von Gallenblasensteinen ? Tierexperimentelle Ergebnisse

“…In der Literatur finden sich ferner Angaben fiber die endoskopische Zerst6rung von Gallengangssteinen via Gallenblase nach Anlegen einer Cholecystostomie und das kombinierte percutane und retrograde Vorgehen zur Behandlung der Choledocholithiasis bei Papillenstenosen [4,7]. Es findet sich auch die Darstellung der percutanen Cholecystolithotomie fiber ein Nephroskop [5].…”