[Transendoscopic mechanical lithotripsy in choledocholithiasis]

When there are large stones in the common bile duct or constrictions of the bile ducts the stones very often cannot pas spontaneously or after an endoscopically performed sphincterotomy. In 54 patients after an unsuccessful attempt to extract the stone with the Dormia-basket endoscopic mechanical lithotripsy was performed followed by balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and securing a bilionasal drainage for prophylaxis of cholangitis. The mechanical lithotripsy was successful in 50 of the patients (92.4%). The jaundice and the cholestasis decreased up to the 10-th day and the cytolytic enzymes became normal. Complications occurred in 2 patients (4%)--hemorrhage up to the 12-th hour after the manipulation. The author recommends, in cases of unsuccessful stone extraction by endoscopic sphincterotomy, the mechanical lithotripsy in combination with balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and nasobiliary drainage for washing the bile ducts, prevention of bile duct occlusion and treatment of cholangitis in cases of unsuccessful extraction by endoscopic sphincterotomy.