MANAGEMENT OF RETAINED BILE-DUCT STONES - A PROSPECTIVE OPEN TRIAL COMPARING EXTRACORPOREAL AND INTRACORPOREAL LITHOTRIPSY

Background: Endoscopic management of common bile duct stones has becom e the approach of choice, especially in patients with high surgical ri sk. Problems are encountered if there are large stones or a duct steno sis. For these difficult stones, shock wave technology serves as an al ternative to surgical intervention. Methods: A total of 125 patients w ith common bile duct stones in whom conventional endoscopic treatment had failed were selected and treated either by extracorporeal piezoele ctric lithotripsy (ESWL, n = 79) or intracorporeal electrohydraulic li thotripsy (EHL, n = 46). The average age of our patients was 70 years. Results: In the ESWL group visualization of the stones by ultrasound and ensuing treatment were possible in 71 out of 79 patients (90%); st ones could be fragmented in 68 patients. The biliary tree could then b e completely freed of caiculi in 62 of 79 patients, a success rate of 78.5%. In the EHL group, stones were successfully fragmented in 38 of 46 patients; 34 patients (74%) eventually became stone free. Thirty-da y mortality was zero in both groups. Combined treatment including ESWL , EHL, and intracorporeal laser lithotripsy was finally successful in 118 patients (94%). Conclusions: Endoscopic management in combination with the lithotripsy techniques described can be recommended as the me thod of choice for treating difficult common bile duct stones. A succe ss rate of almost 100% and a mortality rate of 0% is now the establish ed standard, even in elderly and unstable patients.