title: Extracorporeal shock wave lithotripsy for difficult common bile duct stones: a comparison between 2 different lithotripters in a large cohort of patients.
abstract: BACKGROUND
  Extracorporeal shock wave lithotripsy (ESWL) for difficult common bile duct (CBD) stones is a safe and effective treatment strategy allowing for bile duct clearance in approximately 90% of patients with a low incidence of mild adverse events.
  
  
  OBJECTIVE
  To compare the CBD clearance rates achieved after ESWL performed with 2 different lithotripters (Siemens Lithostar Plus and Storz Modulith SLX-F2) in a large cohort of patients with difficult CBD stones.
  
  
  METHODS
  A retrospective analysis of a prospectively collected database.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  All of the consecutive patients who underwent ESWL because of difficult CBD stones between 1990 and 2012 were considered suitable for inclusion.
  
  
  METHODS
  ESWL with Lithostar Plus or with Modulith SLX-F2.
  
  
  METHODS
  CBD clearance.
  
  
  RESULTS
  Three hundred ninety-two patients with difficult CBD stones were treated; 199 patients were treated with the Lithostar Plus and 193 patients with the Modulith SLX-F2. CBD clearance was achieved in 349 patients (89.0%) with no significant difference between the patients treated with Lithostar Plus and those treated with Modulith SLX-F2 (90.5% vs 87.6%; P = .45). Patients treated with Modulith SLX-F2 underwent a significantly lower number of ESWL sessions (3 [range, 2 to 4] vs 3 [range, 2 to 4]; P = .0015), had a lower incidence of ESWL-related adverse events (5.2% vs 13.6%; P = .009), and never required opioid analgesia (P < .001).
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  The Modulith SLX-F2 allows the same clearance rate as the Lithostar Plus but has a significantly lower incidence of adverse events and requires fewer ESWL sessions.
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Paolo
authors: P
authors: Cecinato
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Lorenzo
authors: L
authors: Fuccio
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Francesco
authors: F
authors: Azzaroli
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Andrea
authors: A
authors: Lisotti
authors: Im3D Medical Imaging Lab, Turin, Italy.
authors: Loredana
authors: L
authors: Correale
authors: Department of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
authors: Cesare
authors: C
authors: Hassan
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Federica
authors: F
authors: Buonfiglioli
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Giulio
authors: G
authors: Cariani
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Mazzella
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Franco
authors: F
authors: Bazzoli
authors: Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Rosangela
authors: R
authors: Muratori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome