Comments on the use of electrohydraulic lithotripsy to treat pill impaction in the esophagus in two adults

We read with interest the recent case report detailing the novel use of electrohydraulic lithotripsy (EHL) for the removal of impacted pills in two adults, a technique that has not been previously described in the literature [1]. While the application of EHL for stones in the genitourinary and hepatobiliary tracts is well established [2], its use for pill impaction in the esophagus presents a unique and potentially valuable approach. Several aspects of the cases presented do however raise questions and warrant further discussion.

First, the cases described in the report involve pill impactions in patients with suspected eosinophilic esophagitis (EoE). A history of food impaction and the presence of a focal stricture are the only factors independently associated with perforation [3]. Given however that the problem with EHL is that the incidental focusing of the shock waves on the esophageal wall may cause bleeding and perforation, the potential impact of these underlying conditions on the effectiveness and safety of EHL in pill removal is an important consideration [4]. Further exploration into how EoE and its associated findings may influence the outcome of EHL treatment in such cases would provide valuable insights for clinicians encountering similar scenarios.

Second, while the use of EHL successfully fragmented the impacted pills in both cases, the report lacks detailed information on the post-procedural outcomes, including the resolution of symptoms, healing of mucosal tears, and potential complications. A discussion of the long-term follow-up and clinical course of these patients after EHL treatment would enhance the understanding of the technique's efficacy and safety in this specific context.

In conclusion, while the report highlights the innovative use of EHL to treat pill impactions in adult patients, further exploration of the interaction between EoE and EHL outcomes, as well as a more comprehensive analysis of post-procedural effects and complications, would enrich the value of the findings. I believe a deeper investigation of these aspects would contribute significantly to the existing knowledge in this area.

Publication History

Article published online:
27 September 2024

• References

• 1 Yoon BH, Yoon JY, Bhagya Rao B. et al. Two cases in which electrohydraulic lithotripsy was used in adults to treat an impacted pill in the esophagus. Endoscopy 2023; 55: E114-E115
• 2 Burhenne HJ. Electrohydrolytic fragmentation of retained common duct stones. Radiology 1975; 117: 721-723 DOI: 10.1148/117.3.721. (PMID: 1081241)
• 3 Runge TM, Eluri S, Cotton CC. et al. Causes and outcomes of esophageal perforation in eosinophilic esophagitis. J Clin Gastroenterol 2017; 51: 805-813 DOI: 10.1097/MCG.0000000000000718. (PMID: 27680593)
• 4 Hendriks S, Verseveld MM, Boevé ER. et al. Successful endoscopic treatment of a large impacted gallstone in the duodenum using laser lithotripsy, Bouveret's syndrome: A case report. World J Gastroenterol 2020; 26: 2458-2463 DOI: 10.3748/wjg.v26.i19.2458. (PMID: 32476805)