Extracorporeal shock wave lithotripsy (ESWL) for bile duct stones

Abstract

Extracorporeal shock wave lithotripsy (ESWL) under X-ray guidance using Dornier MPL9000 was performed on 13 patients with bile duct stones. Previous to ESWL, endoscopic nasobiliary drainage (ENBD) was performed on 12 patients, and percutaneous transhepatic cholangiodrainage (PTCD) was performed on one patient for the purpose of visualising the stones by injection of contrast medium. Shock waves were discharged until the stones were disintegrated enough for usual endoscopic extraction. In 11 of the 12 patients with naso-biliary catheter the stones were successfuly disintegrated and extracted by peroral endoscopic procedure. In one patient with PTCD fragmentation was successfully done and the fragments were extracted using percutaneous transhepatic cholangioscope (PTCS). In one failure case the stone was finally extracted duodenoscopicaly using several methods for lithotripsy. We did not experience serious adverse effect of shock waves.
Our conclusion is th a t ESWL is one of the choice for the treatment of bile duct stones especially such stones as difficult for usual endoscopic extraction.