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

ESWL offers a new possibility for the treatment of patients suffering from bile duct stones, in cases where endoscopic methods failed. From September 1987 to June 1989 80 patients (56 women, 24 men; mean age: 66 years) had been selected for ESWL at the Charité-Hospital. Indications were: Impacted stones (30 patients), very large stones (22 patients), stones above bile duct strictures (28 patients). 79 patients have been treated by device "Lithostar" (Siemens) during 114 sessions in abdominal position under X-ray visualization. ESWL-treatment was impossible in one patient because of technical reasons. Per treatment session 1000 to 5000 shock waves with an energy of 19 kV, directed on a single or distributed among several stones, have been applied. In 79 cases out of 114 treatments complete or partial fragmentation (69.3%) was attained. Stone fragments were removed endoscopically in 56 patients and in 1 patient percutaneously via biliary drainage. In 5 cases the fragments passed spontaneously. On the total, in 72.2% of our patients stones clearance was achieved. No severe side effects could be observed.

ESWL represents a proper method increasing the effectiveness and lowering the risks of non-operative therapy by bile duct stones.