ENDOSCOPIC MECHANICAL LITHOTRIPSY (EML) OF BILIARY TRACT STONES

Abstract

The effect of endoscopic mechanical lithotripsy (EML) of biliary tract stones was clinically evaluated by using a mechanical basket-tipped lithotriptor which was specially made by Olympus Optical Co. of Tokyo. The instrument consists of an intensive basket -tipped catheter incorporated within a stainless steel sheath and a handle manipulator with a clamping screw rack. In our experimental studies, biliary tract stones caught by the basket were easily crushed by this instrument with its strong clamping power. Endoscopic mechanical lithotripsy (EML) was attempted in 12 patients with choledo-cholithiasis following endoscopic sphincterotomy (EST). A newly developed side-viewing duodenoscope (Olympus, TJF-10) with a larger instrument channel of 4.2 mm in diameter was also employed in this procedure. The EML was successfully accomplished in 11 of 12 patients with complete removal of stones and without any complications. In the remaining one, the procedure failed because of unsuccessful catching of a stone by the basket probe. The results apparently show that the EML is a safe and effective procedure and makes it possible to retrieve huge stones within the common bile duct. The technique can eliminate the limitation of noninvasive endoscopic removal of biliary tract stones and can enlarge the indications for EST.