Crushing Stones: Mechanical, Intracorporeal and Extracorporeal Lithotripsy in the Clearance of Common Bile Duct Lithiasis

Abstract

Mechanical, intracorporeal and extracorporeal lithotripsy were used in the treatment of common bile duct lithiasis in a series of 80 patients in whom initial extraction attempts with the Dormia basket and balloon catheter failed. Mechanical lithotripsy was performed in 74 cases and was successful in 38 (51.3%). Among the 36 patients with failure of mechanical lithotripsy, five had an initial attempt at stone dissolution w1th methyl terr-butyl ether (MTBE) infused through a nasobiliary stent. This was successful in four cases; the stones did not disappear completely - however, they were smaller and easier to extract. Of the remaining 32 patients who failed mechanical lithotripsy, two underwent success[, l surgical stone extraction with no further attempts at nonoperative treatment and 30 underwent complementary shock wave lithotripsy. Extracorporeal lithotripsy was used in 19 of these patients. The intracorporeal lithotripsy group of21 patients comprised 11 with failed mechanical lithotripsy, six in whom no ocher treatment was attempted and four in whom extracorporeal lithotripsy had failed. Extracorporeal lithotripsy was successful in 15 cases (79%) and intracorporeal lithotripsy in 19 (90%). There were four treatment failures, with one patient death due to cholangitis and respiratory failure. In summary, mechanical lithotripsy is an effective and safe treatment modality but has a high failure rate. Extracorporeal lithotripsy is useful and should he attempted where available, but is not always successful. Intracorporeal lithotripsy is very efficient but requires either the transpapillary route, which is technically difficult, or the transhepatic route which carries associated complications.