Abstract
Background and Study Aims: The efficacy of extracorporeal shock-wave lithotripsy (ESWL) of difficult bile duct
stones that were not amenable to routine endoscopic extraction was assessed, with
evaluation of the long-term follow-up after successful treatment.
Patients and Methods: Fifty-four patients (mean age 74 years, range 33-92) were treated with ESWL for difficult
bile duct stones. Treatment was performed either with the Dornier HM3 kidney lithotriptor
(49 patients) or with the MPL 9000 lithotriptor (five patients).
Results: Stone disintegration was achieved in 50 patients (93 %), with complete stone clearance
in 45 patients (83 %) (mean 1.2 sessions). Patients with successful stone removal
after one session had significantly smaller stones than patients with treatment failure
(20 ± 9 versus 27 ± 8 mm; p < 0.05). An intrahepatic location of stones was significantly
associated with treatment failure (p < 0.005). Severe complications occurred in 7 %
(procedure-related 5 %), with a 30-day mortality rate of 0 % (in-hospital mortality
rate of 2 %). Minor side effects such as fever, petechiae, and mild arrhythmias were
frequent (37 %), and microhematuria (94 %) occurred in nearly all of the patients.
Symptomatic recurrent bile duct stones were observed in two patients (5 %) after three
and four years, respectively (mean follow-up 5.3 years).
Conclusion: Extracorporeal shock wave lithotripsy represents a safe and effective treatment modality
for difficult bile duct stones, with a low rate of symptomatic recurrences.
