PROBLEMATIC BILE-DUCT STONES - POLYVALENT TREATMENT

Background. The availability of different methods for the nonsurgical treatment of complicated bile duct stones makes it possible to choose the most appropriate therapy on the basis of the particular characteri stics of each individual case and a careful evaluation of their relate d risks/benefits/costs. Methods. The present study involved 26 patient s treated using different techniques; in some cases, after the failure of the first approach, one of the alternative treatments was adopted, Twenty-one of the patients had isolated stones that were large (>20 m m in diameter: 11 cases), impacted (5) or upstream of a stenotic tract ; five had multiple stones (two of whom had undergone previous biliodi gestive anastomosis and two had Caroli's disease). The initial treatme nt in 24/26 cases was chemical litholysis with a 2:1 v/v association o f monooctanoin and methyl tert-butyl ether. Results, Total dissolution was obtained in nine cases and partial dissolution leading to subsequ ent elimination (spontaneous or by means of a basket and/or saline was hout) in eight. In the seven patients in whom chemolitholysis was unsu ccessful, clearance was obtained surgically (6 cases) or by means of e xtracorporeal shockwave lithotripsy (ESWL). The remaining two patients were successfully treated by means of first-choice ESWL and saline wa shout. Conclusions, The results confirm that the variability of compli cated bile duct stones requires the use of a multimodal approach.