title: ESWL experience in the therapy of difficult bile duct stones.
abstract: In recent years, alternatives to surgery for difficult bile duct stones have been developed. Routine endoscopy fails in about 10% of patients. To verify the role of extracorporeal shock wave lithotripsy in residual CBD stones, we treated 32 patients by HM4 or MPL 9000 Dornier lithotripters. Ten (34.4%) patients needed two extracorporeal shock wave lithotripsy sessions, and 3 (10.3%) patients three. Complete clearance was achieved in 29 patients (90.6%) after one or more sessions either by endoscopic (20 pts) or percutaneous (9 pts) extraction of the debris; of the remaining 3 patients, in 2 a bilioduodenal stent was placed and in 1 electrohydraulic lithotripsy was performed. Eighteen and seven-tenths percent transient mild hemobilia, 12.5% microhematuria, and no mortality were observed. It is possible to state that in site- or size-related difficult biliary stones, extracorporeal shock wave lithotripsy is a rapid, safe, and highly effective treatment as an additional nonoperative option to resolve the failure of routine endoscopic measures.
authors.affiliation: II Clinica Chirurgica, University La Sapienza of Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lomanto
authors.forename: F
authors.initials: F
authors.lastname: Fiocca
authors.forename: M
authors.initials: M
authors.lastname: Nardovino
authors.forename: E
authors.initials: E
authors.lastname: Grasso
authors.forename: E
authors.initials: E
authors.lastname: Lezoche
authors.forename: E
authors.initials: E
authors.lastname: Zarba Meli
authors.forename: A
authors.initials: A
authors.lastname: Paganini
authors.forename: V
authors.initials: V
authors.lastname: Speranza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D001663:Bilirubin / Q000097:blood; D002769:Cholelithiasis / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008096:Lithotripsy / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin