OUTCOME OF MECHANICAL LITHOTRIPSY OF BILE-DUCT STONES IN AN UNSELECTED SERIES OF 704 PATIENTS

Background/Aims: This paper evaluates the potential benefit of non mec hanical bile duct stone lithotripsy techniques. The efficacy, limitati ons and risks of mechanical lithotripsy as first choice procedure were studied. Material and Methods: Endoscopic sphincterotomy was performe d by Erlangen-type papillotomes, stone extraction by Olympus baskets a nd mechanical lithotripsy by the Wurbs-system. In an unselected series of 704 patients, everyone with common bile and hepatic duct stones (i ndependent of size, number, location and stone consistency) was includ ed in the study. Results: Complete stone clearance by endoscopic sphin cterotomy and basket extraction was possible in 87.6%. Additional mech anical lithotripsy led to a success rate of 98.4% and in combination w ith ESWL of 98.5%. In 11 patients without possibility of endoscopic st one removal (1.6%), 4 had no access transpapillary problems (S-shaped common bile duct, intrahepatic stones or impacted stones in cystic duc t orifice), and 2 refused further endoscopic interventions. Complicati on rate was 1.4% (therof 1.1% successful treatment by endoscopic or su rgical means), lethality rate 0.3%. Conclusions: A very high rate of s tone clearance by standard endoscopic procedures is possible. In those patients where mechanical lithotripsy is not successful, other non-su rgical lithotriptic procedures either cannot be applied because of ana tomical reasons or if performed, the improvement in success rate is ma rginal.