Endoscopy 2018; 50(04): S69
DOI: 10.1055/s-0038-1637232
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 3: Hot topics and post liver transplantation
Georg Thieme Verlag KG Stuttgart · New York

SAFETY AND EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR DIFFICULT-TO-RETRIEVE COMMON BILE DUCT STONES: A TEN YEAR EXPERIENCE

M Manzoor ul Haque
1   Sindh Institute of Urology and Transplantation, Hepatobiliary, Karachi, Pakistan
,
N Hassan Luck
1   Sindh Institute of Urology and Transplantation, Hepatobiliary, Karachi, Pakistan
,
A Ali Tasneem
1   Sindh Institute of Urology and Transplantation, Hepatobiliary, Karachi, Pakistan
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

Extracorporeal shock wave lithotripsy (ESWL) for common bile duct (CBD) stones has been used in the past but experience is limited. We, herein, report our experience regarding ESWL in the management of difficult to retrieve biliary stones.

Methods:

Study was conducted from January 2007 to January 2017 in the department of Hepatogastroenterology, SIUT. All patients with difficult to retrieve CBD stones who underwent ESWL were enrolled. Stones were targeted fluoroscopically after injection of contrast through nasobiliary drain (NBD). Outcome was assessed by CBD clearance.

Results:

Eighty three patients were included, mean age 50.5 ± 14.5; predominantly females 43 (51.8%). Patients with large stones > 15 mm were seen in 64 (77.1%), CBD stricture in 22 (26.5%) and incarcerated stone in 8 (9.6%) patients. Jaundice was present in 73 (75.9%), cholangitis 29 (34.9%), fever 35 (42.2%) and right upper abdominal pain 72 (86.7%). A total of 178 ESWL sessions were performed in 83 patients, with 2.1 ± 1.2 sessions of lithotripsy. In 75 (90.3%) patients, the fragments were extracted endoscopically after ESWL, while spontaneous passage was observed in 08 (9.6%) patients. Total CBD clearance was achieved in 67 (80.6%) patients, partial clearance in 5 (6%) and no response in 11 (13.2%). Failure of the treatment was observed in patients with large stone size ≥2.0 cm (p = 0.021), presence of incarcerated stone (p = 0.020) and pre ERCP cholangitis (p = 0.047). Most frequent side effects were transient microscopic hematuria 11 (13.3%), fever 11 (13.3%), cholangitis 9 (10.8%) and hemobilia 3 (3.6%). ESWL session could not be completed or temporarily held in 15 (18.1%) patients. Total hospital stay was 9.6 ± 4.8 days.

Conclusions:

ESWL is noninvasive, safe and effective therapeutic alternative to surgical exploration for difficult biliary stones.