INTRA-CORPOREAL SHOCKWAVE LITHOTRIPSY IN COMPLEX BILE-DUCT LITHIASIS - COMPARISON OF ENDOSCOPIC TECHNIQUES AND FOLLOW-UP RESULTS

Objectives. - About 2 % of common bite duct stones and most intra-hepa tic stones cannot be removed by conventional endoscopy. Intra-corporea l lithotripsy is an alternative technique for these patients. Contact lithotripsy can be obtained by compared and assessed the results of th ese two methods. Methods. - Thirty-seven patients (79 +/- 9.8 years, 2 5 women and 12 men) underwent laser lithotripsy (n = 21), electro-hydr aulic lithotripsy (n = 9) or both methods consecutively (n = 7) for co mmon bile duct stories (n = 31), intra-hepatic stones (n = 3) or diffu se lithiasis (n = 3). The mean diameter of the largest stone was 23 +/ - 12 mm. Lithotripsy was performed by a retrograde approach in 35 case s and a combined retrograde and transhepatic approach in 2 cases.Resul ts. - The mean number of lithotripsy sessions wa ns 1.5 +/- 0.65. The overall success rate (free bile ducts with patent drainage) was 95%. I n 2 patients, stones were not fully extracted : one underwent surgery, the other one was treated conservatively with antibiotics. The durati on of the hospital stay was 9.3 +/- 4.5 days. Morbidity at 30 days was 27 % and only one case of major morbidity (hemorrhage after sphincter otomy 2.7 %) was observed. There were no procedure-related mortality. Electro-hydraulic and laser groups did not differ significantly for su ccess rate, morbidity and time spent at hospital. Follow-up informatio n was obtained in 34 patients (91.8 %) a median of 17 months after lit hotripsy (range : 4-52 months). Ten patients died of non-biliary disea ses. Two patients (5.8 %) development biliary symptoms 24 and 34 month s after lithotripsy, one after unsuccessful lithotripsy. Conclusion. - Intracorporeal lithotripsy is a valuable tool for the most complex ca ses of duct stones, and with an acceptable morbidity. The results of t he two techniques are similar. Late biliary complications after intrac orporeal lithotripsy appear to be rare.