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Endoscopic mechanical lithotripsy of difficult common bile duct stones
L Cipolletta1, G Costamagna, M A Bianco
1Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale Agostino Maresca, Torre del Greco, Università Cattolica del Sacro Cuore, Rome, Italy.
Background:
Mechanical lithotripsy for the management of difficult common bile duct stones has sometimes yielded conflicting results.
Methods:
A series of 162 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome.
Results:
The procedure was safe (morbidity rate 1.8 per cent) and effective (84.0 per cent stone clearance rate). Univariate and multivariate analysis showed that stone size was the only outcome predictor (mean(s.d.) diameter of grasped versus non-grasped stones 21.7 (6.7) versus 28.3(10.4) mm; F = 10.72, 98 d.f., P = 0.002). The cumulative probability of bile duct clearance ranged from over 90 per cent for stones with a diameter less than 10 mm to 68 per cent for those greater than 28 mm in diameter (P < 0.02).
Conclusion:
Patients at high risk of lithotripsy failure (stone diameter of 28 mm or more) might more wisely undergo surgery or other non-surgical procedures, such as extracorporeal shock-wave lithotripsy or long-term biliary stenting.