title: [Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones].
abstract: OBJECTIVE
  The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction.
  
  
  METHODS
  From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy. The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs. Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy. After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically.
  
  
  RESULTS
  The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases. All presented jaundice and pain and nine (47.3%) presented associated cholangitis. Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session. In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract. The treatment failed in 3 patients who were referred for surgical treatment. No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome.
  
  
  CONCLUSIONS
  Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones. It represents a therapeutic alternative in patients at high surgical risk.
authors.affiliation: Unidad de Endoscopias. Servicios de Medicina Digestiva. Hospital La Fe. Valencia. España. iuliusmora@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Mora
authors.forename: V
authors.initials: V
authors.lastname: Aguilera
authors.forename: T
authors.initials: T
authors.lastname: Sala
authors.forename: F
authors.initials: F
authors.lastname: Martínez
authors.forename: G
authors.initials: G
authors.lastname: Bastida
authors.forename: A
authors.initials: A
authors.lastname: Palau
authors.forename: L
authors.initials: L
authors.lastname: Argüello
authors.forename: V
authors.initials: V
authors.lastname: Pons
authors.forename: V
authors.initials: V
authors.lastname: Pertejo
authors.forename: J
authors.initials: J
authors.lastname: Berenguer
authors.forename: J M
authors.initials: JM
authors.lastname: Alapont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000628:therapy; D002769:Cholelithiasis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome