Extracorporeal shock wave lithotripsy for clearance of bile duct stones resistant to endoscopic extraction

Background: Endoscopic extraction of bile duct stones after sphincterotomy has a success rate of up to 95%. Failures occur in patients with extremely large stones, intrahepatic stones, and bile duct strictures. This study exa mined the efficacy and the safety of extracorporeal shock-wave lithotripsy in a large cohort of patients in whom routine endoscopic measures including mechanical lithotripsy had failed to extract bile duct stones. Methods: Out of 1587 consecutive patients, endoscopic stone extraction incl uding mechanical lithotripsy was unsuccessful in 313 (20%). These 313 patie nts (64% women, median age, 73 years) underwent high-energy extracorporeal shock-wave lithotripsy. Stone targeting was performed fluoroscopically (99% ) or by ultrasonography (1%). Results: Complete clearance of bile duct calculi was achieved in 281 (90%) patients. In 80% of the patients, the fragments were extracted endoscopical ly after shock-wave therapy; spontaneous passage was observed in 10%. For p atients with complete clearance compared with those without there were no d ifferences with regard to size or number of the stones, intrahepatic or ext rahepatic stone location, presence or absence of bile duct strictures, or t ype of lithotripter. Cholangitis (n = 4) and acute cholecystitis (n = 1) we re the rare adverse effects. Conclusions: In patients with bile duct calculi that are difficult to extra ct endoscopically, high-energy extracorporeal shock-wave lithotripsy is a s afe and effective therapy regardless of stone size, stone location, or the presence of bile duct stricture.