Extracorporeal Shock Wave Lithotripsy of Bile Duct Stones
Second-generation extracorporeal shock wave lithotripsy (ESWL) devices (such as the Siemens Lithostar that we have in use) are as effective as the original Dornier HM3 lithotripteras far as fragmentation of gallstones, but there are some advantages to the second-generation devices: easier focusing, no anesthesia requirements, shorter operating room time, easier patient positioning, and the possibility of performing endoscopy on the same table. We treated 13 non-selected patients with bile duct stones.
All the patients underwent a preliminary endoscopic papillosphincterotomy (EPT) to allow gallstones to evacuate and to position a nasobiliary probe for contrast medium injection. Complete fragmentation was obtained in all cases. Of 13 patients, 11 spontaneously eliminated the fragments; two patients required endoscopic basketing for fragment removal. We observed no side effects. The risk of surgical removal of bile duct stones is significant; in the last few years the extraction of bile duct stones using endoscopy has improved their management. Adding ESWL to endoscopic treatment allows us to obtain a fast recovery, the possibility of treating intrahepatic or large stones, and an improved success rate. Using this method, it is also possible to cure high-risk patients without anesthesia unless endoscopic procedures are required.
KeywordsBile Duct Common Bile Duct Obstructive Jaundice Extracorporeal Shock Wave Lithotripsy Bile Duct Stone