title: Clearance of refractory bile duct stones with Extracorporeal Shockwave Lithotripsy: higher failure rate in obese patients.
abstract: OBJECTIVE
  Bile duct stones that cannot be removed endoscopically are still a challenge in interventional gastroenterology. Extracorporeal shockwave lithotripsy (ESWL) with subsequent endoscopic extraction of residual fragments is an established treatment option if other endoscopic means are not successful. Our study aimed to investigate the efficacy and safety of ESWL for clearance of refractory bile duct stones.
  
  
  METHODS
  A total of 73 consecutive patients treated for refractory choledocholithiasis with ESWL were retrospectively analyzed. Success and complication rates were calculated.
  
  
  RESULTS
  Complete stone clearance was achieved in 66 cases (90%). Patients with complete clearance had a significantly lower body mass index or BMI (25.55 ± 5.01 kg/m² vs. 31.60 ± 6.26 kg/m², p = 0.035) and needed less ESWL treatments (3.61 ± 1.87 vs. 5.00 ± 1.63, p = 0.048). A relevant drop of hemoglobin occurred significantly more often in the group with partial clearance (43% vs. 6%, p = 0.005).
  
  
  CONCLUSIONS
  ESWL proves to be an excellent clearing approach to refractory bile duct stones with high success rates. However, obesity is one risk factor for ESWL failure and higher procedural hazard.
authors.affiliation: Department of Medicine B, University Hospital Münster , Münster , Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lenze
authors.forename: Hauke S
authors.initials: HS
authors.lastname: Heinzow
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Berssenbrügge
authors.forename: Helen
authors.initials: H
authors.lastname: Rothenbächer
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Ullerich
authors.forename: Martin
authors.initials: M
authors.lastname: Floer
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Dirk
authors.initials: D
authors.lastname: Domagk
authors.forename: Tobias
authors.initials: T
authors.lastname: Meister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D042883:Choledocholithiasis / Q000097:blood / Q000150:complications* / Q000628:therapy*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D006454:Hemoglobins