[Endoscopic mechanical lithotripsy in choledocholithiasis of difficult extraction handling]

Large stones are difficult to remove in block through a small papillotomy, a relative narrowed distal bile duct, periampular diverticula or in those who have undergone only balloon sphincteroplasty prior to stone extraction. Extending the papillotomy is not always possible, and may carry, an increased risk of bleeding and perforation. Lithotripsy facilitates stone extraction and clearance of the common bile duct.

This study investigated the predictors of successful or unsuccessful mechanical lithotripsy.

A series of 100 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome.

The procedure was safe (morbidity rate 4.4%) and effective (68% stone clearance rate). The statistic analysis showed that lithotripter type was the only outcome predictor (p = 0.044). The other factors analyzed were not statistically significance.

Mechanical lithotripsy is successful in about 70% of patients with difficult bile duct stones. The only significant factor that predicts failure of mechanical lithotripsy is lithotripter type.