Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones.
Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL. Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatment and the remaining 29 (13%) constituted our study group; 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.
Harz
C
C
Abteilung für Endoskopie, Fakultät für Klinische Medizin, Universität Heidelberg, Mannheim, Federal Republic of Germany.
Henkel
T O
TO
Köhrmann
K U
KU
Pimentel
F
F
Alken
P
P
Manegold
B C
BC
D000368:Aged; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D012306:Risk