Korean Journal of Gastrointestinal Endoscopy 1999;19(3): 379-385.
체외충격파쇄석술을 병행한 담관결석의 내시경적 치료 ( Endoscopic Removal of Difficult Bile Duct Stones Combined with Extracorporeal Shock Wave Lithotripsy )
이영홍, 박찬욱, 문종호, 조영덕, 김연수, 이문성, 심찬섭 (Young Hong Lee, Chan Wook Park, Jong Ho Moon, Young Deok Cho, Yun Soo Kim, Moon Sung Lee and Chan Sup Shim)
Abstract
Background/Aims: Nowadays, common bile duct stones are predominantly extracted endoscopically, after endoscopic papillotomy. Nearly 90% of stones can be removed with a Dormia basket or mechanical lithotripter. In the remaining patients several nonoperative procedures serve as alternatives to surgery. Once extracorporeal lithotripsy had been successfully used for gallbladder stones, this technique was extended to bile duct stones. An experience of endoscopic removal of difficult bile duct stones combined with extracorporeal shock wave lithotripsy (ESWL) is reported. Methods: 82 patients were selected for this treatment because conventional stone extraction had failed. The Biolithos Mark III was used for extracorporeal spark-gap lithotripsy and the shock wave number was 2,000 waves (average) at one session. The stones were detected through a fluoroscopy with dye injection through an endoscopic naso-biliary drainage tube. After the fragmentation of bile duct stones, endoscopic removal of stones was performed for the facilitation of the complete removal of the stones, and to decrease the discomfort of the patients for the duration of their stay. Results: Visualization of the stones using a fluoroscopy with dye injection was possible in all patients. On average, these patients had 3.1 (1∼7) sessions of treatment with ESWL. Fragmentation was achieved in 74 (90.2%) patients and complete stone removal occurred in 71 (86.5%) patients. Complete stone clearance was achieved without further intervention in 8 (11.3%) patients, and in 63 (88.7%) patients after endoscopic extraction of the fragments. Thirty-seven (58.7%) patients underwent one endoscopic intervention to extract the remaining fragments. In 54 (81.8%) patients, a balloon catheter or Dormia basket was sufficient to extract the remaining fragments and an additional mechanical lithotripsy was necessary to break down larger fragments in 12 (18.2%) patients. There were no serious adverse effects from ESWL. Conclusions: Endoscopic removal combined with ESWL is also a useful method for the treatment of difficult bile duct stones to facilitate the complete removal of the stones and to decrease the discomfort of the patients, as well as the duration of their hospitalization. (Korean J Gastrointest Endosc 19: 379∼385, 1999)
PDF Links
Full text via DOI 
Download Citation 
