Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers.
BACKGROUND
PD and common bile duct (CBD) stones often require mechanical lithotripsy (ML) at ERCP for successful extraction. The frequency and spectrum of complications is not well described in the literature.


OBJECTIVE
To describe the frequency and spectrum of complications of ML.


METHODS
A comprehensive retrospective review of cases requiring ML of large or resistant PC and/or CBD stones using a 46-point data questionnaire on type(s) of complication, treatment attempted, and success of treatment. The study involved 7 tertiary referral centers with 712 ML cases (643 biliary and 69 pancreatic).


RESULTS
Overall incidence of complications were: 4-4% (31/712); 23/643 biliary, 8/69 pancreatic; 21 single, 10 multiple. Biliary complications: trapped (TR)/broken (BR) basket (N = 11), wire fracture (FX) (N = 8), broken (BR) handle (N = 7), perforation/duct injury (N = 3). Pancreatic complications: TR/BR basket (N = 7), wire FX (N = 4), BR handle (N = 5), pancreatic duct leak (N = 1). Endoscopic intervention successfully treated complications in 29/31 cases (93.5%). Biliary group treatments: sphincterotomy (ES) extension (N = 7), electrohydraulic lithotripsy (EHL) (N = 11), stent (N = 3), per-oral Soehendra lithotripsy (N = 8), surgery (N = 1), extracorporeal lithotripsy (N = 5), and dislodge stones/change basket (N = 4). Pancreatic group treatments: ES extension (N = 3), EHL (N = 2), stent (N = 5), Soehendra lithotriptor (N = 4), dislodge stones/change basket (N = 2), extracorporeal lithotripsy (ECL) (N = 1), surgery (N = 1). Perforated viscus patient died at 30 days.


CONCLUSIONS
The majority of ML in expert centers involved the bile duct. The complication rate of pancreatic ML is threefold greater than biliary lithotripsy. The most frequent complication of biliary and pancreatic ML is trapped/broken baskets. Extension of ES and EHL are the most frequently utilized treatment options.
Thomas
Miriam
M
St. Luke's Medical Center, Pancreatic Biliary Center, Milwaukee, Wisconsin, USA.
Howell
Douglas A
DA
Carr-Locke
David
D
Mel Wilcox
C
C
Chak
Amitabh
A
Raijman
Isaac
I
Watkins
James L
JL
Schmalz
Michael J
MJ
Geenen
Joseph E
JE
Catalano
Marc F
MF
D002137:Calculi / Q000139:chemically induced / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D004868:Equipment Failure; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects* / Q000379:methods; D010183:Pancreatic Ducts