title: Extracorporeal shock wave lithotripsy of common bile duct stones in patients with increased operative risk.
abstract: OBJECTIVE
  Assessment of efficacy of extracorporeal shock wave lithotripsy (ESWL) of stones in the common bile duct.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Department of Surgery, University Hospital Rotterdam, Rotterdam, The Netherlands.
  
  
  METHODS
  90 patients with stones in the common bile duct and at increased operative risk (median age 73 years, range 27-95).
  
  
  METHODS
  After failure of endoscopic measures, the first 13 patients were treated under general anaesthesia with a first generation lithotriptor. Of the next 77 patients, treated with a second generation lithotriptor, only one required general anaesthesia and 68 intravenous analgesia and sedation. Eight patients needed no analgesia at all.
  
  
  METHODS
  Fragmentation, clearance, and recurrence of stones.
  
  
  RESULTS
  Fragmentation of stones was achieved in all the first 13 patients and 63 of the 90 patients (69%). There were minor complications (macroscopic haematuria and subcapsular haematoma of the right kidney) in 13 and serious complications (bacteraemia) in 2. At follow-up (median 28 months), 2 patients had recurrent stones.
  
  
  CONCLUSIONS
  ESWL of stones in the common bile duct is safe and effective and should be considered in high risk patients.
authors.affiliation: Department of Surgery, University Hospital Rotterdam, The Netherlands.
authors.forename: R L
authors.initials: RL
authors.lastname: van der Hul
authors.forename: P W
authors.initials: PW
authors.lastname: Plaisier
authors.forename: M
authors.initials: M
authors.lastname: van Blankenstein
authors.forename: O T
authors.initials: OT
authors.lastname: Terpstra
authors.forename: R
authors.initials: R
authors.lastname: den Toom
authors.forename: H A
authors.initials: HA
authors.lastname: Bruining
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome