ESWL EXPERIENCE IN THE THERAPY OF DIFFICULT BILE-DUCT STONES

In recent years, alternatives to surgery for difficult bile duct stone s have been developed. Routine endoscopy fails in about 10% of patient s. To verify the role of extracorporeal shock wave lithotripsy in resi dual CBD stones, we treated 32 patients by HM4 or MPL 9000 Dornier lit hotripters. Ten (34.4%) patients needed two extracorporeal shock wave lithotripsy sessions, and 3 (10.3%) patients three. Complete clearance was achieved in 29 patients (90.6%) after one or more sessions either by endoscopic (20 pts) or percutaneous (9 pts) extraction of the debr is; of the remaining 3 patients, in 2 a bilioduodenal stent was placed and in 1 electrohydraulic lithotripsy was performed. Eighteen and sev en-tenths percent transient mild hemobilia, 12.5% microhematuria, and no mortality were observed. It is possible to state that in site- or s ize-related difficult biliary stones, extracorporeal shock wave lithot ripsy is a rapid, safe, and highly effective treatment as an additiona l nonoperative option to resolve the failure of routine endoscopic mea sures.