Extracorporeal shock wave lithotripsy of common bile duct stones in patients with increased operative risk.

OBJECTIVE

Assessment of efficacy of extracorporeal shock wave lithotripsy (ESWL) of stones in the common bile duct.

DESIGN

Prospective clinical study.

SETTING

Department of Surgery, University Hospital Rotterdam, Rotterdam, The Netherlands.

SUBJECTS

90 patients with stones in the common bile duct and at increased operative risk (median age 73 years, range 27-95).

INTERVENTIONS

After failure of endoscopic measures, the first 13 patients were treated under general anaesthesia with a first generation lithotriptor. Of the next 77 patients, treated with a second generation lithotriptor, only one required general anaesthesia and 68 intravenous analgesia and sedation. Eight patients needed no analgesia at all.

MAIN OUTCOME MEASURES

Fragmentation, clearance, and recurrence of stones.

RESULTS

Fragmentation of stones was achieved in all the first 13 patients and 63 of the 90 patients (69%). There were minor complications (macroscopic haematuria and subcapsular haematoma of the right kidney) in 13 and serious complications (bacteraemia) in 2. At follow-up (median 28 months), 2 patients had recurrent stones.

CONCLUSION

ESWL of stones in the common bile duct is safe and effective and should be considered in high risk patients.