Biliary lithotripsy by extracorporeal shock waves: integral part of nonsurgical intervention

Nine patients with cholelithiasis were selected for adjuvant therapy with extracorporeal shock-wave lithotripsy when radiologic or endoscopic intervention alone had been unsuccessful for stone removal. This preliminary experience with shock-wave lithotripsy includes four patients with one or more common duct stones, one patient with a large solitary gallbladder stone, and four patients with impacted cystic duct stones. Lithotripsy failed in two patients with cystic duct stones. The seven patients with successful lithotripsy underwent subsequent fragment extraction by intervention via T-tube tract, minicholecystostomy, or endoscopic sphincterotomy. Our approach to cholelithotripsy varied from previous reports in that we included patients with cystic duct stones, relied on interventional fragment removal without adjuvant chemolitholysis, and treated four patients with acute symptoms or multiple risk factors. Our initial experience with biliary lithotripsy in selected patients indicates that it can play an integral part in nonsurgical intervention for cholelithiasis.