Hungarian Radiology

[The role of the mechanical lithotripsy for the treatment of ”difficult” common bile duct stones]

OROSZ Péter, NAGY György, SÜMEGI János, JUHÁSZ László

APRIL 20, 2003

Hungarian Radiology - 2003;77(02)

[INTRODUCTION - Present work aimed to identify some predictors of success or failure (gender, age, number and size of stones, presence of periampullary diverticula and jaundice) in mechanical lithotripsy. PATIENTS AND METHODS - 7998 endoscopic retrograde cholangio-pancreatographies, 2430 endoscopic sphincterotomies and 1205 bile duct stone extractions were performed between 1981 and 2000 years. In 159 patients - because of failure of standard techniques - mechanical lithotripsy was attempted for crushing of large bile duct stones. There were 39 men (mean age 70.5 years) and 120 women (mean age 67.7 years). 65 patients had single stone, 31 had 2 stones and 63 had multiple stones. 80 patients had larger stones than 20 mm in diameter. 23 patients had periampullary diverticula and 98 were jaundiced. Mechanical lithotripsy was accomplished with Olympus BML 2Q and BML 4Q intraendoscopic systems. When the first attempt failed, repeated treatment was performed or a Wilson-Cook extraendoscopic system was used. Data of predictors were processed using univariate analysis, Chi-square test and Fischer’s exact test. P<0.05 was regarded as statistically significant. RESULTS - Clearance of common bile duct was obtained in 130 patients (81.8%). Procedure related cholangitis occured in 16 patients. 8 pancreatitis developed, 7 of them subsided with conservative therapy, 1 of them required surgical treatment. On univariate analysis, the stone size was the only variable to differentiate the success from failure of procedure (p<0.05). Other variables had not any role in determining the outcome. CONCLUSION - Mechanical lithotripsy is a useful method with a high success rate and with an acceptable complication rate for treatment of ”difficult” bile duct stones. Stone size is the single outcome predictor.]

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