Abstract
Background and Study Aims: Endoscopic extraction of bile duct stones may be complicated by impaction of the
Dormia basket with captured stones, or rupture of the traction wire of the basket
during mechanical lithotripsy. In an attempt to release impacted baskets by nonoperative
means, we studied the efficacy of extracorporeal shock-wave lithotripsy in this dangerous
clinical situation.
Patients and Methods: Fourteen extracorporeal shock-wave treatments were performed in 12 consecutive patients
(eight women and four men; mean age 73.2 ± 13.2 years, range 46-86 years) with an
electrohydraulic shock-wave lithotriptor, using fluoroscopy (n = 13) or ultrasound
(n = 1) for targeting. A total of 1845 ± 334 (mean ± SD) shock-wave discharges at
a voltage of 22 ± 4 kV were delivered per treatment. Nine treatment sessions (64 %)
were performed while patients were under general anesthesia. An attempt to extract
the Dormia basket was made after disintegration of the captured stone had been confirmed
by fluoroscopy.
Results: It was possible to remove the Dormia basket by nonsurgical means in 11 of the 12
patients (92 %) after one treatment session, and after three treatment sessions in
the remaining patient. Thus, disintegration of the stones allowed extraction of the
Dormia basket in all patients. None of the patients needed surgical intervention.
All patients were rendered free of bile duct stones after extracorporeal shock-wave
lithotripsy and subsequent endoscopic removal of the fragments. No adverse effects
of shock-wave therapy with subsequent extraction of the Dormia baskets were observed.
Conclusion: Shock-wave therapy represents a primary nonsurgical therapeutic option in patients
with either impacted Dormia baskets or broken devices which cannot be extracted by
endoscopic means.
