title: Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy.
abstract: BACKGROUND
  Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
  
  
  OBJECTIVE
  To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
  
  
  METHODS
  Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
  
  
  RESULTS
  Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
  
  
  CONCLUSIONS
  Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.
authors.affiliation: Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Ellis
authors.forename: A P
authors.initials: AP
authors.lastname: Jenkins
authors.forename: R P
authors.initials: RP
authors.lastname: Thompson
authors.forename: R J
authors.initials: RJ
authors.lastname: Ede
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001569:Benzodiazepines; D001649:Bile Duct Diseases / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000628:therapy*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D003287:Contrast Media; D001569:Benzodiazepines; D008614:Meperidine