Abstract
Successful treatment of renal stones have been recently reported with an extracorpor-eal shock-wave lithotriptor. The authors attempted to apply the lithotriptor to the treatment of big stones in the common bile duct which are not amenable to the extraction with a basket catheter. The first step was started with an in vitro experiment : a gall stone obtained during a surgical operation was exposed to the shock-wave in vitro. The stone was fragmented after 750 shock-wave exporuses. Consequently, the next step was taken to apply the lithotripter to two patients with big stones which had been found in the common bile duct some years after cholecystectomy, because the endoscopic papillotomy and extraction of the stones with a basket catheter was unsuccessful. The two patients were exposed to the extracorporeal shock-wave under epidural anesthesia and under the guidance of radiogra-phy after injecting contrast material through the endoscopic nasobiliary tube which had been detained following the endoscopic papillotomy. The fragmented stones were easily removed with an endoscopic basked catheter 2 days after in one case ; and the stones were found to have disappeared 4 days later in the other case. The results suggest that the extracorporeal shock-wave lithotripsy will prove to be useful for the treatment of big stones in the common bile duct. Further clinical studies are now in progress.
