Extracorporeal shock-wave lithotripsy for retained common bile duct stones

Retained common bile duct stones (CBDS) become a challenging problem when p ercutaneous and endoscopic methods fail. Extracorporeal shock-wave lithotri psy (ESWL) is a noninvasive and effective treatment modality, and can be us ed as an alternative treatment of retained CBDS. We report our experience w ith 20 patients who had retained CBDS, using a second-generation electromag netic lithotriptor. Thirteen patients who had cholecystectomy and common bi le duct exploration, with stone extraction and T-tube drainage, were in the early postoperative period. Seven patients had undergone previous endoscop ic sphincterotomy and nasobiliary drainage. Fourteen patients had only one ESWL session. Stone fragmentation rates were 100% and 57% in patients with T-tube and nasobiliary catheter, respectively. The overall stone fragmentat ion rate was 85% and complete stone clearance was achieved in all these pat ients (85%). Complications were mild and relatively infrequent (20%). There was no mortality. We conclude that ESWL for retained CBDS is a safe, effec tive and minimally-invasive treatment modality. ESWL should be considered a s a significant alternative to surgery when endoscopic and percutaneous tre atment modalities are not successful.