Fragmentation of bile duct stones by extracorporeal shock‐wave lithotripsy: A five‐year experience

Abstract

Over 5 yr, 103 elderly patients (mean age = 70 yr) with bile duct stones (mainly not amenable to endoscopic extraction) underwent adjuvant extracorporeal shock‐wave lithotripsy using a first‐generation kidney lithotripter. Disintegration of stones was achieved after a mean of 1.4 sessions in 92% of the patients. Spontaneous passage of fragments into the duodenum occurred in one fourth of the patients, and endoscopic extraction of fragments was necessary in 75% of the patients, resulting in complete clearance of the bile duct stones in 91 (88%) of 103 patients. The most important adverse effect was septic disease after extracorporeal shock‐wave lithotripsy in 4% of the patients. The 30‐day mortality rate was 1% (one patient), and another 15 patients died during a mean follow‐up of 26 ± 14 mo (mainly of causes unrelated to biliary tract disease). Two of 91 patients who had been rendered stone free were readmitted because of recurrent stone disease during the follow‐up period. Of the 43 patients who still had their gallbladders during extracorporeal shock‐wave lithotripsy, 14% subsequently underwent cholecystectomy. These data show that extracorporeal shock‐wave lithotripsy of bile duct stones is a useful and safe adjunct to nonsurgical procedures for the removal of calculi in the biliary tree. (HEPATOLOGY 1992;15:208‐214). Copyright © 1992 American Association for the Study of Liver Diseases