Outcome of Simple Use of Mechanical Lithotripsy of Difficult Common Bile Duct Stones

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2005 Jan 11

PMID 15641153

Citations 37

Authors

Wen-Hsiung Chang

Cheng-Hsin Chu

Tsang-En Wang

Ming-Jen Chen

Ching-Chung Lin

Affiliations

Soon will be listed here.

Abstract

Aim: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL), where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL) or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance.

Methods: During the period from August 1996 to December 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients.

Results: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis, and 10 patients had delayed bleeding, and no patient died. Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis, and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1.4%) had cholangitis, 1 (0.4%) had delayed bleeding, and 7 patients (3.3%) had pancreatitis. Statistical deviation was present in post-procedure cholangitis, delayed bleeding, and pancreatitis of both groups.

Conclusion: Mechanical bile stone lithotripsy on difficult bile duct stones could produce around 90% successful rate. Moreover, complications are minimal. This finding further confirms the significance of mechanical lithotripsy in the treatment of patients with difficult bile duct stones.

Citing Articles

Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue.

Manti M, Shah J, Papaefthymiou A, Facciorusso A, Ramai D, Tziatzios G Medicina (Kaunas). 2024; 60(2).

PMID: 38399627 PMC: 10890215. DOI: 10.3390/medicina60020340.

Cost-effective analysis of preliminary single-operator cholangioscopy for management of difficult biliary stones.

Sljivic I, Trasolini R, Donnellan F Endosc Int Open. 2022; 10(9):E1193-E1200.

PMID: 36118645 PMC: 9473834. DOI: 10.1055/a-1873-0884.

Application and usefulness of a new eight-wire basket catheter for endoscopic extraction of small common bile duct stones: A retrospective multicenter study.

Inatomi O, Katayama M, Soga K, Yamamoto T, Mikami T, Morita Y DEN Open. 2022; 3(1):e138.

PMID: 35898821 PMC: 9307736. DOI: 10.1002/deo2.138.

Large Gallstones Stacked Together in the Common Bile Duct after Choledochojejunostomy.

Sakamoto Y, Takeda Y, Kawahara S, Shimosaka T, Hamamoto W, Koda H Intern Med. 2022; 61(17):2613-2617.

PMID: 35185053 PMC: 9492497. DOI: 10.2169/internalmedicine.8956-21.

Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques.

Troncone E, Mossa M, De Vico P, Monteleone G, Del Vecchio Blanco G Medicina (Kaunas). 2022; 58(1).

PMID: 35056428 PMC: 8779004. DOI: 10.3390/medicina58010120.

References

Sand J, Airo I, Hiltunen K, Mattila J, Nordback I . Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy. Am Surg. 1992; 58(5):324-8. View

Chung S, Leung J, Leong H, Li A . Mechanical lithotripsy of large common bile duct stones using a basket. Br J Surg. 1991; 78(12):1448-50. DOI: 10.1002/bjs.1800781214. View

Lai K, Lo G, Lin C, Hsu P, Chan H, Cheng J . Do patients with recurrent choledocholithiasis after endoscopic sphincterotomy benefit from regular follow-up?. Gastrointest Endosc. 2002; 55(4):523-6. DOI: 10.1067/mge.2002.122611. View

Ueno N, Ozawa Y, Aizawa T . Prognostic factors for recurrence of bile duct stones after endoscopic treatment by sphincter dilation. Gastrointest Endosc. 2003; 58(3):336-40. DOI: 10.1067/s0016-5107(03)00004-x. View

Binmoeller K, Bruckner M, Thonke F, Soehendra N . Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy. 1993; 25(3):201-6. DOI: 10.1055/s-2007-1010293. View

Cipolletta L, Costamagna G, Bianco M, Rotondano G, Piscopo R, Mutignani M . Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg. 1997; 84(10):1407-9. View

Kim D, Kim M, Lee S, Seo D, Choi W, Lee S . Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc. 2001; 54(1):42-8. DOI: 10.1067/mge.2001.115335. View

Neuhaus H, Zillinger C, Born P, Ott R, Allescher H, Rosch T . Randomized study of intracorporeal laser lithotripsy versus extracorporeal shock-wave lithotripsy for difficult bile duct stones. Gastrointest Endosc. 1998; 47(5):327-34. DOI: 10.1016/s0016-5107(98)70214-7. View

Wojtun S, Gil J, Gietka W, Gil M . Endoscopic sphincterotomy for choledocholithiasis: a prospective single-center study on the short-term and long-term treatment results in 483 patients. Endoscopy. 1997; 29(4):258-65. DOI: 10.1055/s-2007-1004186. View

10.

Sugiyama M, Atomi Y . Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000; 52(2):187-91. DOI: 10.1067/mge.2000.107285. View

11.

Fujita N, Maguchi H, Komatsu Y, Yasuda I, Hasebe O, Igarashi Y . Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. Gastrointest Endosc. 2003; 57(2):151-5. DOI: 10.1067/mge.2003.56. View

12.

Adamek H, Maier M, Jakobs R, Wessbecher F, Neuhauser T, Riemann J . Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy. Gastrointest Endosc. 1996; 44(1):40-7. DOI: 10.1016/s0016-5107(96)70227-4. View

13.

Bergman J, van Berkel A, Groen A, Schoeman M, Offerhaus J, Tytgat G . Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy. Gastrointest Endosc. 1997; 45(5):400-5. DOI: 10.1016/s0016-5107(97)70151-2. View

14.

Prat F, Fritsch J, Choury A, Frouge C, Marteau V, ETIENNE J . Laser lithotripsy of difficult biliary stones. Gastrointest Endosc. 1994; 40(3):290-5. DOI: 10.1016/s0016-5107(94)70058-3. View

15.

Tanaka M, Takahata S, Konomi H, Matsunaga H, Yokohata K, Takeda T . Long-term consequence of endoscopic sphincterotomy for bile duct stones. Gastrointest Endosc. 1998; 48(5):465-9. DOI: 10.1016/s0016-5107(98)70086-0. View

16.

Hagege H, Berson A, Pelletier G, Fritsch J, Choury A, Liguory C . Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis. Endoscopy. 1992; 24(4):248-51. DOI: 10.1055/s-2007-1010476. View

17.

Schreiber F, Gurakuqi G, Trauner M . Endoscopic intracorporeal laser lithotripsy of difficult common bile duct stones with a stone-recognition pulsed dye laser system. Gastrointest Endosc. 1995; 42(5):416-9. DOI: 10.1016/s0016-5107(95)70042-0. View

18.

Higuchi T, Kon Y . Endoscopic mechanical lithotripsy for the treatment of common bile duct stone. Experience with the improved double sheath basket catheter. Endoscopy. 1987; 19(5):216-7. DOI: 10.1055/s-2007-1013015. View

19.

Hintze R, Adler A, Veltzke W . Outcome of mechanical lithotripsy of bile duct stones in an unselected series of 704 patients. Hepatogastroenterology. 1996; 43(9):473-6. View

20.

Shaw M, Mackie R, Moore J, Dorsher P, Freeman M, Meier P . Results of a multicenter trial using a mechanical lithotripter for the treatment of large bile duct stones. Am J Gastroenterol. 1993; 88(5):730-3. View