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[Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones]. 2002

J Mora, and V Aguilera, and T Sala, and F Martínez, and G Bastida, and A Palau, and L Argüello, and V Pons, and V Pertejo, and J Berenguer, and J M Alapont
Unidad de Endoscopias. Servicios de Medicina Digestiva. Hospital La Fe. Valencia. España. iuliusmora@hotmail.com

OBJECTIVE The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction. METHODS From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy. The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs. Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy. After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically. RESULTS The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases. All presented jaundice and pain and nine (47.3%) presented associated cholangitis. Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session. In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract. The treatment failed in 3 patients who were referred for surgical treatment. No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome. CONCLUSIONS Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones. It represents a therapeutic alternative in patients at high surgical risk.

UI MeSH Term Description Entries
D008096 Lithotripsy The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is LITHOTRIPSY, LASER. ESWL (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsy,Extracorporeal Shockwave Lithotripsy,Litholapaxy,Noninvasive Litholapaxy,Percutaneous Ultrasonic Lithotripsy,Ultrasonic Lithotripsy,ESWLs (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsies,Extracorporeal Shockwave Lithotripsies,Litholapaxies,Litholapaxies, Noninvasive,Litholapaxy, Noninvasive,Lithotripsies,Lithotripsies, Electrohydraulic Shockwave,Lithotripsies, Extracorporeal Shockwave,Lithotripsies, Percutaneous Ultrasonic,Lithotripsies, Ultrasonic,Lithotripsy, Electrohydraulic Shockwave,Lithotripsy, Extracorporeal Shockwave,Lithotripsy, Percutaneous Ultrasonic,Lithotripsy, Ultrasonic,Noninvasive Litholapaxies,Percutaneous Ultrasonic Lithotripsies,Shockwave Lithotripsies, Electrohydraulic,Shockwave Lithotripsies, Extracorporeal,Shockwave Lithotripsy, Electrohydraulic,Shockwave Lithotripsy, Extracorporeal,Ultrasonic Lithotripsies,Ultrasonic Lithotripsies, Percutaneous,Ultrasonic Lithotripsy, Percutaneous
D008297 Male Males
D002760 Cholangiopancreatography, Endoscopic Retrograde Fiberoptic endoscopy designed for duodenal observation and cannulation of VATER'S AMPULLA, in order to visualize the pancreatic and biliary duct system by retrograde injection of contrast media. Endoscopic (Vater) papillotomy (SPHINCTEROTOMY, ENDOSCOPIC) may be performed during this procedure. ERCP,Endoscopic Retrograde Cholangiopancreatography,Retrograde Cholangiopancreatography, Endoscopic,Cholangiopancreatographies, Endoscopic Retrograde,Endoscopic Retrograde Cholangiopancreatographies,Retrograde Cholangiopancreatographies, Endoscopic
D002761 Cholangitis Inflammation of the biliary ductal system (BILE DUCTS); intrahepatic, extrahepatic, or both. Cholangitides
D002769 Cholelithiasis Presence or formation of GALLSTONES in the BILIARY TRACT, usually in the gallbladder (CHOLECYSTOLITHIASIS) or the common bile duct (CHOLEDOCHOLITHIASIS). Gallstone Disease,Cholelithiases,Gallstone Diseases
D003131 Combined Modality Therapy The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used. Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D005069 Evaluation Studies as Topic Works about studies that determine the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. Critique,Evaluation Indexes,Evaluation Methodology,Evaluation Report,Evaluation Research,Methodology, Evaluation,Pre-Post Tests,Qualitative Evaluation,Quantitative Evaluation,Theoretical Effectiveness,Use-Effectiveness,Critiques,Effectiveness, Theoretical,Evaluation Methodologies,Evaluation Reports,Evaluation, Qualitative,Evaluation, Quantitative,Evaluations, Qualitative,Evaluations, Quantitative,Indexes, Evaluation,Methodologies, Evaluation,Pre Post Tests,Pre-Post Test,Qualitative Evaluations,Quantitative Evaluations,Report, Evaluation,Reports, Evaluation,Research, Evaluation,Test, Pre-Post,Tests, Pre-Post,Use Effectiveness
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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