[Role of extracorporeal shock wave lithotripsy in the treatment of common bile duct and intrahepatic calculi].

The management of intrahepatic and common bile duct stones has been modified by the advent of endoscopic sphincterotomy and percutaneous extraction through a T-tube tract or transhepatic access. Occasionally, nonoperative extraction is incomplete. The use of extracorporeal lithotripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years) were treated by extracorporeal shockwave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had previously undergone a cholecystectomy and 44% exploration of the common duct. Patients were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the lithotripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patient were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobiliary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalities contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessary in order to obtain those results.