LITHOTRIPSY IN THE TREATMENT OF BILIARY STONES

Noninvasive or minimally invasive techniques for the treatment of bili ary stones have been significantly advanced in the past two decades. T he least invasive, extracorporeal shock-wave lithotripsy, continues to be used successfully, not only at its earliest reported site of use i n Munich, Germany, but also in numerous other centers in the world. Li thotriptors that utilize a spark gap electrode or other source of ener gy to generate sound waves and imaging by radiographic and ultrasonogr aphic targeting of stones have proved to be effective in fragmenting b iliary stones (90% to 95%) that are too large or otherwise inaccessibl e to removal by endoscopic papillotomy. Stone clearance (53% to 90%) m ay require successive treatments and the removal of debris by transend oscopic or surgical means. The mortality is low (0.5%), and the posttr eatment course is relatively uncomplicated in an elderly, high-risk gr oup of patients.