EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR COMMON BILE-DUCT STONES

Background Successful extraction of common bile duct stones after endo scopic sphincterotomy may be achieved in 86-96 per cent of cases. Howe ver, some stones are too large to be removed in this manner. This stud y looks at the role of extracorporeal shock-wave lithotripsy to break up common bile duct stones as an adjunct to sphincterotomy in patients with stones greater than 10 mm in size.Methods Twenty-seven patients with large (10-35 mm) common bile duct stones were treated with piezoe lectric generated extracorporeal shock-wave lithotripsy (ESWL) followi ng failed stone extraction after endoscopic sphincterotomy (ES). The s tones were visualized ultrasonographically and a piezolith 2300 Wolf l ithotripter used to administer the shockwaves. Results Visualized ston e fragmentation was reported in 20 of 48 sessions. Clearance of target ed stones was achieved in 18 of the 27 patients, but actual duct clear ance was demonstrated in only 17 of the 27. There were few adverse eff ects and mortality was nil. Conclusion This study concludes that ESWL following failed ES is a useful additional treatment option for very l arge bile duct stones, but should only be used after surgical risk and past history of biliary disease have been carefully reviewed and foun d to contraindicate conventional surgical management. An algorithm of treatment options for common bile duct stones is presented.