[Extracorporeal shockwave lithotripsy (ESWL)--a new procedure for treating choledocholithiasis]

Area of Science:

• Gastroenterology
• Endourology
• Medical Technology

Background:

• Bile duct stones pose a significant clinical challenge, often requiring invasive procedures.
• Endoscopic methods, while effective, may fail in cases of impacted, large, or impacted stones above strictures.
• Extracorporporeal shock wave lithotripsy (ESWL) presents a potential alternative for difficult-to-treat bile duct stones.

Purpose of the Study:

• To evaluate the efficacy and safety of ESWL for treating bile duct stones.
• To assess ESWL as an alternative when endoscopic treatments are unsuccessful.
• To determine stone clearance rates and identify potential complications.

Main Methods:

• A prospective study involving 80 patients with bile duct stones treated between September 1987 and June 1989.
• Indications included impacted stones (30), large stones (22), and stones above strictures (28).
• Treatment was performed using the Siemens "Lithostar" device, delivering 1000-5000 shock waves per session under X-ray guidance.

Main Results:

• ESWL was attempted in 79 patients over 114 sessions.
• Complete or partial stone fragmentation was achieved in 69.3% of treatments.
• Overall stone clearance was achieved in 72.2% of patients, with fragments removed endoscopically, percutaneously, or passed spontaneously.
• No severe side effects were reported during the study.

Conclusions:

• ESWL is a viable and effective method for non-operative treatment of bile duct stones.
• It offers increased effectiveness and reduced risks compared to conventional therapies, particularly for challenging cases.
• ESWL expands therapeutic options for patients with bile duct stones unresponsive to endoscopic procedures.