ENDOSCOPIC TREATMENT OF MIRIZZI SYNDROME

Electrohydraulic lithotripsy has been shown to be an effective non-sur gical treatment for common bile duct and intrahepatic duct stones. Thi s technique was applied via the endoscopic retrograde route in 14 pati ents (mean age, 70) with the Mirizzi syndrome, all of whom were at hig h risk for surgery. The procedure was performed under strict cholangio scopic guidance. Twelve patients had a single stone and two had multip le stones impacted in the cystic duct. Stone diameter was 1.5 cm in on e patient, 2 to 3 cm in nine patients, and greater than 3 cm in four p atients. Insertion of the babyscope and stone fragmentation were succe ssful in all patients. Complete stone clearance required one session i n 12 patients and two sessions in two patients (both with multiple sto nes). In one patient post-procedural leakage of contrast medium from t he cystic duct into the peritoneal cavity was noted. This was attribut ed to pressure necrosis induced by the impacted stone. The patient had an uneventful course of recovery, and leakage resolved with conservat ive management. Mortality was zero. Endoscopic treatment of the Mirizz i syndrome with electrohydraulic lithotripsy seems to be an effective and relatively safe alternative to surgery.