Endoscopic treatment of retained bile-duct stones by using a balloon catheter for electrohydraulic lithotripsy without cholangioscopy.
BACKGROUND
Electrohydraulic lithotripsy is a highly effective method for fragmenting biliary stones, but direct visual control is required. The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones that could not be extracted by using standard techniques.


METHODS
Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventional endoscopic methods, e.g., mechanical lithotripsy, were selected to undergo electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0 F radio-opaque tip was inserted through a balloon catheter. Electrohydraulic lithotripsy was performed under fluoroscopy until the fragmented stone could be captured in a large basket for mechanical lithotripsy. Endoscopic removal of the fragments was attempted during the electrohydraulic lithotripsy session.


RESULTS
Stones were successfully fragmented in 17 of 19 patients. In 16 patients (84.2%), the bile duct was cleared of all stones. A mean of 1.8 endoscopic sessions was required for complete removal. Additional mechanical lithotripsy was performed in 9 (56.2%) of the 16 patients. Minor complications were noted in 4 patients (2 hemobilia, 1 pancreatitis, 1 cholangitis). There was no 30-day mortality.


CONCLUSIONS
For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be an effective method of fragmentation.
Moon
Jong Ho
JH
Digestie Disease Center, Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Cha
Sang Woo
SW
Ryu
Chang Beom
CB
Kim
Young Seok
YS
Hong
Su Jin
SJ
Cheon
Young Koog
YK
Cho
Young Deok
YD
Kim
Yun Soo
YS
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Shim
Chan Sup
CS
Kim
Boo Sung
BS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome