Extracorporeal Shock Wave Lithotripsy in the Treatment of Large Common Bile Duct Stones

Abstract

Retained stones in the common bile duct remain a clinical problem in 2% to 5% of patients undergoing cholecystectomy. Extraction through a T-tube or via an endoscopic papillotomy is successful in 85% to 95% of patients. There remains, however, a sizable group of patients who require reoperation with its attendant risk of morbidity and mortality. A recent study by Paumgartner et al. suggests that ESWL may be useful for fragmenting large common bile duct stones. A study was undertaken to evaluate the efficacy of ESWL in fragmenting common bile duct stones that were too large to be extracted via a T-tube or endoscopic papillotomy.

Three patients were entered into the study. Age ranged from 62 to 92 years. All patients had either severe, preexisting systemic disease, or were of an advanced age and had failed attempts at extraction via the T-tube or by endoscopie papillotomy. Patients were treated with 2,400 to 3,300 shock waves at 20 kV.

Stones were successfully fragmented in all patients. All patients were free of common bile duct stones at 30 days by repeat endoscopie retrograde cholangiopancreatography (ERCP). ESWL seems to be an effective adjuvant treatment in clearing the common bile duct of stones that would otherwise require additional surgery.