[Extracorporeal piezoelectric and intracorporeal electrohydraulic lithotripsy in problematic bile duct calculi]

More than 90% of all common bile duct stones are today extracted endoscopically after papillotomy with the Dormia basket in combination with the mechanical lithotripter. For patients with endoscopically unremovable stones, there are now new therapies as an alternative to surgical intervention. Ductal stones can either be fragmented by extracorporeal shock wave lithotripsy or by peroral cholangioscopic guided electrohydraulic lithotripsy. The remaining fragments can then be easily extracted endoscopically. If the stone cannot be removed by using these new techniques, a palliative endoprosthesis can by implanted. We report on our experiences and results with the extracorporeal piezoelectric shock wave lithotripsy and the intracorporeal electrohydraulic therapy in 44 patients with complicated bile duct stones. Applying extracorporeal shock wave therapy, treatment was successful in 75% of the patients with common bile duct stones, intracorporeal electrohydraulic lithotripsy was successful in 71%. By combination of both techniques, the calculi could be removed in 84% of those patients where before one of both therapies had failed. Finally, the rate of success in the above mentioned 44 patients was 93%. It could be shown by this investigation that both therapeutic methods complete each other in the treatment of the complicated common bile duct stones.