Skip to main content
NCBI home page
Gut logoLink to Gut
. 2000 Nov;47(5):728–731. doi: 10.1136/gut.47.5.728

Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

R Ellis 1, A Jenkins 1, R Thompson 1, R Ede 1
PMCID: PMC1728118  PMID: 11034593

Abstract

BACKGROUND—Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
AIMS—To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
METHODS—Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
RESULTS—Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
CONCLUSION—Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.


Keywords: lithotripsy; bile duct calculi; extracorporeal lithotripsy

Full Text

The Full Text of this article is available as a PDF (103.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brückner M., Grimm H., Soehendra N. Electrohydraulic lithotripsy of complicated choledocholithiasis. Endoscopy. 1990 Sep;22(5):234–235. doi: 10.1055/s-2007-1012855. [DOI] [PubMed] [Google Scholar]
  2. Chaussy C., Schüller J., Schmiedt E., Brandl H., Jocham D., Liedl B. Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology. 1984 May;23(5 Spec No):59–66. doi: 10.1016/0090-4295(84)90243-7. [DOI] [PubMed] [Google Scholar]
  3. Clouse M. E., Stokes K. R., Lee R. G., Falchuk K. R. Bile duct stones: percutaneous transhepatic removal. Radiology. 1986 Aug;160(2):525–529. doi: 10.1148/radiology.160.2.3726136. [DOI] [PubMed] [Google Scholar]
  4. Cotton P. B., Kozarek R. A., Schapiro R. H., Nishioka N. S., Kelsey P. B., Ball T. J., Putnam W. S., Barkun A., Weinerth J. Endoscopic laser lithotripsy of large bile duct stones. Gastroenterology. 1990 Oct;99(4):1128–1133. doi: 10.1016/0016-5085(90)90634-d. [DOI] [PubMed] [Google Scholar]
  5. Dr. Joachim Burhenne. AJR Am J Roentgenol. 1980 May;134(5):888–888. doi: 10.2214/ajr.134.5.888. [DOI] [PubMed] [Google Scholar]
  6. Lee S. H., Fache J. S., Burhenne H. J. The value of extracorporeal shock-wave lithotripsy in the management of bile duct stones. AJR Am J Roentgenol. 1990 Oct;155(4):775–779. doi: 10.2214/ajr.155.4.2119107. [DOI] [PubMed] [Google Scholar]
  7. Lindström E., Borch K., Kullman E. P., Tiselius H. G., Ihse I. Extracorporeal shock wave lithotripsy of bile duct stones: a single institution experience. Gut. 1992 Oct;33(10):1416–1420. doi: 10.1136/gut.33.10.1416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Moody F. G., Amerson J. R., Berci G., Bland K. L., Cotton P. B., Graham J. B., Jones R. S., Maher J. W., Munson J. L., Pennell T. C. Lithotripsy for bile duct stones. Am J Surg. 1989 Sep;158(3):241–247. doi: 10.1016/0002-9610(89)90257-2. [DOI] [PubMed] [Google Scholar]
  9. Neoptolemos J. P., Hofmann A. F., Moossa A. R. Chemical treatment of stones in the biliary tree. Br J Surg. 1986 Jul;73(7):515–524. doi: 10.1002/bjs.1800730703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Nicholson D. A., Martin D. F., Tweedle D. E., Rao P. N. Management of common bile duct stones using a second-generation extracorporeal shockwave lithotriptor. Br J Surg. 1992 Aug;79(8):811–814. doi: 10.1002/bjs.1800790835. [DOI] [PubMed] [Google Scholar]
  11. Sauerbruch T., Holl J., Sackmann M., Paumgartner G. Fragmentation of bile duct stones by extracorporeal shock-wave lithotripsy: a five-year experience. Hepatology. 1992 Feb;15(2):208–214. doi: 10.1002/hep.1840150207. [DOI] [PubMed] [Google Scholar]
  12. Sauerbruch T., Stern M. Fragmentation of bile duct stones by extracorporeal shock waves. A new approach to biliary calculi after failure of routine endoscopic measures. Gastroenterology. 1989 Jan;96(1):146–152. doi: 10.1016/0016-5085(89)90775-0. [DOI] [PubMed] [Google Scholar]
  13. Staritz M., Rambow A., Grosse A., Hurst A., Floth A., Mildenberger P., Goebel M., Junginger T., Hohenfellner R., Thelen M. Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience. Gut. 1990 Feb;31(2):222–225. doi: 10.1136/gut.31.2.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Vellacott K. D., Powell P. H. Exploration of the common bile duct: a comparative study. Br J Surg. 1979 Jun;66(6):389–391. doi: 10.1002/bjs.1800660605. [DOI] [PubMed] [Google Scholar]
  15. Weiss W., Türk C., Brownstone E., Hruby W., Klose W., Kölbl C., Marberger M., Tuchmann A. Klinische Relevanz der extrakorporalen Stosswellenlithotripsie (ESWL) bei Choledocholithiasis. Wien Klin Wochenschr. 1989 Sep 29;101(18):629–631. [PubMed] [Google Scholar]
  16. Wenzel H., Greiner L., Jakobeit C., Lazica M., Thüroff J. Extrakorporale Stosswellenlithotripsie von Gallengangssteinen. Dtsch Med Wochenschr. 1989 May 12;114(19):738–743. doi: 10.1055/s-2008-1066665. [DOI] [PubMed] [Google Scholar]
  17. den Toom R., Nijs H. G., van Blankenstein M., Laméris J. S., Schröder F. H., Terpstra O. T. Extracorporeal shock wave treatment of common bile duct stones: experience with two different lithotriptors at a single institution. Br J Surg. 1991 Jul;78(7):809–813. doi: 10.1002/bjs.1800780714. [DOI] [PubMed] [Google Scholar]
  18. van der Hul R. L., Plaisier P. W., van Blankenstein M., Terpstra O. T., den Toom R., Bruining H. A. Extracorporeal shock wave lithotripsy of common bile duct stones in patients with increased operative risk. Eur J Surg. 1994 Jan;160(1):31–35. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES