title: ESWL for difficult bile duct stones: a 15-year single centre experience.
abstract: OBJECTIVE
  To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) for the management of refractory bile duct cholelithiasis in a third level referral centre.
  
  
  METHODS
  The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus, SIEMENS) from October 1990 to April 2005 were evaluated. All patients were monitored during the procedure and antibiotics were administered in case of cholangitis. The chi(2) test and logistic regression analysis were performed as appropriate.
  
  
  RESULTS
  Two hundred and fourteen patients (102 males, 112 females; mean age 74.8 +/- 0.84 years--single stone 97, multiple stones 117) underwent ESWL. The mean number of sessions and shock waves were 3.5 +/- 0.13 and 3477.06 +/- 66.17, respectively. The maximum stone size was 5 cm. Complete stone clearance was achieved in 192 (89.7%) patients. Of the remaining patients 15 required surgery, 2 a palliative stent and in 5 patients stone fragmentation led to effective bile drainage with clinical resolution despite incomplete clearance. Age, sex and stone characteristics were not related to treatment outcome. Major complications occurred in two patients (haemobilia and rectal bleeding) and minor complications in 25 (3 vomiting, 22 arrhythmias). No procedure-related deaths occurred.
  
  
  CONCLUSIONS
  ESWL is a safe and effective technique for clearance of refractory bile duct stones.
authors.affiliation: Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. rosangela.muratori@aosp.bo.it
authors.forename: Rosangela
authors.initials: R
authors.lastname: Muratori
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.forename: Flavio
authors.initials: F
authors.lastname: Alessandrelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Cecinato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
authors.forename: Enrico
authors.initials: E
authors.lastname: Roda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000628:therapy*; D005260:Female; D006431:Hemobilia / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
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