How to predict the outcome of endoscopic mechanical lithotripsy in patients with difficult bile duct stones?
OBJECTIVE
Endoscopic mechanical lithotripsy is frequently used to overcome the difficulties of removing large bile duct stones endoscopically. The aim of this study was to identify predictors of endoscopic mechanical lithotripsy failure.


METHODS
One hundred and thirty-four patients who underwent mechanical lithotripsy for difficult choledocholithiasis were evaluated retrospectively. Predictive factors of outcome and procedure-related complications were analyzed. The clinical outcomes of subsequent management were also evaluated in cases of unsuccessful endoscopic mechanical lithotripsy.


RESULTS
Endoscopic mechanical lithotripsy was successful in 102 patients (76.1%). Stone impaction, size (>or=30 mm), and the stone size to bile duct diameter ratio (>1.0) were significant predictors of endoscopic mechanical lithotripsy failure, with estimated odds ratios of 17.83, 4.32 and 5.47, respectively. There was no difference in complication rates between the successful and failed mechanical lithotripsy groups. When mechanical lithotripsy failed, all patients were successfully treated using various modalities, including surgery, without mortality.


CONCLUSIONS
An impacted stone, stone size (>or=30 mm) and stone size to bile duct diameter ratio (>1.0) were predictors of failure of endoscopic mechanical lithotripsy for a difficult bile duct stone. Alternative approaches should be considered in patients with predictors of unsuccessful endoscopic mechanical lithotripsy in order to avoid wasting time and resources.
Lee
Sang Hyub
SH
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Park
Joo Kyung
JK
Yoon
Won Jae
WJ
Lee
Jun Kyu
JK
Ryu
Ji Kon
JK
Kim
Yong-Tae
YT
Yoon
Yong Bum Bum
YB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure