EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSIE (E SWL) OF BILE-DUCT STONES WITHOUT PRIOR SPHINCTEROTOMY

In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-d uct stones after recent laparoscopic cholecystectomy or age below 25 y ears) the chances of successful treatment by ESWL without sphincteroto my were examined. In 15 patients with solitary stones measuring up to 14 mm ''pulverization-ESWL'' produced complete freedom from stones aft er spontaneous migration of fragments through the intact papilla. Only two patients with two ductal stones measuring up to 15 mm still had r esidual fragments in the bile duct after treatment. The ideal stone fo r ESWL without sphincterotomy is thus the solitary bile-duct stone mea suring up to 14 mm. Before performing a high-risk sphincterotomy, befo re re-operation and in young patients one should therefore always exam ine whether ESWL without sphincterotomy is indicated.