Two approaches for electrohydraulic lithotripsy in the common bile duct.

Electrohydraulic lithotripsy is a method used to break up a stone by electric discharge in the presence of liquid medium. After the effect of crushing gallstones was tested in vitro, efficacy and safety of this method were investigated with 11 mongrel dogs. When the electrode was in touch with or close to the bile duct wall, the discharge caused perforation or potentially serious mucosal injury. However, a stone held in a basket catheter combined with the lithotripsy probe was fragmented safely in the bile duct in all the animals. Bile duct manometry showed a transient fall, which was followed by a slight increase, of the pressure on crushing the stone. After these studies in animals, three patients with stones in the common bile duct were treated successfully with the device via the percutaneous transhepatic route (one patient) or through the duodenoscopic route (two patients). Two approaches are now available for electrohydraulic lithotripsy in the common bile duct.