EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY FOR BILE-DUCT CALCULI

BACKGROUND: Bile duct calculi (BDC) can be cleared or treated with mod ern endoscopic techniques in most patients, However, large stones, bil e duct strictures, or unusual anatomy may make endoscopic clearance di fficult, The purpose of the present study was to determine the efficac y of extracorporeal shock-wave lithotripsy (ESWL) in treating patients with complicated BDC. METHODS: Between 1989 and January 1995, 16 pati ents with BDC were treated at our institution with ESWL using a Dornie r HM-3 lithotropter. The average age of patients was 62 years (range 3 2 to 88), Endoscopic retrograde cholangiopancreatography (ERCP) with s phincterotomy and attempted stone extraction (100%), nasobiliary drain age (83%), and biliary stents (6%) were used prior to ESWL. Eleven pat ients (61%) had solitary stones, ranging in diameter from 0.5 to 2.6 c m, whereas 7 patients had multiple stones, ranging in diameter from 0. 5 to 5.0 cm, The indications for ESWL were stone impaction (56%), ston e size (38%), and bile duct stricture (6%), RESULTS: The 16 patients r eceived 27 ESWL treatments (mean = 2101 shock at 21 kV); with 4 patien ts (22%) requiring multiple treatments. Stone fragmentation was achiev ed in 94% of patients, All patients had ERCP performed post-ESWL, and only 2 (13%) patients required immediate operations, At discharge, 94% of patients were stone-free, Minor complications leg, pain, hematuria ) were common, With an average follow-up of 3 years, only 1 patient (6 %) has required retreatment for BDC. Hepatic transplantation was requi red in an additional patient. CONCLUSIONS: In this cohort of patients with both major medical comorbidities and/or technical contraindicatio ns to standard methods of endoscopic and surgical clearance of BDC, we found that ESWL facilitated stone clearance in 94% of patients with m inimal morbidity and no mortality, In our opinion, ESWL should be used more frequently in the treatment of these complex patients. (C) 1998 by Excerpta Medica, Inc.