title: Long-term follow-up after treatment of common bile duct stones by extracorporeal shock-wave lithotripsy.
abstract: OBJECTIVE
  The efficacy of extracorporeal shock-wave lithotripsy (ESWL) of difficult bile duct stones that were not amenable to routine endoscopic extraction was assessed, with evaluation of the long-term follow-up after successful treatment.
  
  
  METHODS
  Fifty-four patients (mean age 74 years, range 33-92) were treated with ESWL for difficult bile duct stones. Treatment was performed either with the Dornier HM3 kidney lithotriptor (49 patients) or with the MPL 9000 lithotriptor (five patients).
  
  
  RESULTS
  Stone disintegration was achieved in 50 patients (93%), with complete stone clearance in 45 patients (83%) (mean 1.2 session). Patients with successful stone removal after one session had significantly smaller stones than patients with treatment failure (20 +/- 9 versus 27 +/- 8 mm; p < 0.05). An intrahepatic location of stones was significantly associated with treatment failure (p < 0.005). Serve complications occurred in 7% (procedure-related 5%), with a 30-day mortality rate of 0% (in-hospital mortality rate of 2%). Minor side effects such as fever, petechiae, and mild arrhythmias were frequent (37%), and microhematuria (95%) occurred in nearly all of the patients. Symptomatic recurrent bile duct stones were observed in two patients (5%) after three and four years, respectively (mean follow-up 5.3 years).
  
  
  CONCLUSIONS
  Extracorporeal shock wave lithotripsy represents a safe and effective treatment modality for difficult bile duct stones, with a low rate of symptomatic recurrences.
authors.affiliation: Dept. of Internal Medicine, University Hospital, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Meyenberger
authors.forename: U
authors.initials: U
authors.lastname: Meierhofer
authors.forename: C
authors.initials: C
authors.lastname: Michel-Harder
authors.forename: J
authors.initials: J
authors.lastname: Knuchel
authors.forename: H P
authors.initials: HP
authors.lastname: Wirth
authors.forename: H
authors.initials: H
authors.lastname: Bühler
authors.forename: R
authors.initials: R
authors.lastname: Münch
authors.forename: J
authors.initials: J
authors.lastname: Altorfer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome