Brief Article
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World J Gastroenterol. Sep 7, 2010; 16(33): 4159-4163
Published online Sep 7, 2010. doi: 10.3748/wjg.v16.i33.4159
ESWL for difficult bile duct stones: A 15-year single centre experience
Rosangela Muratori, Francesco Azzaroli, Federica Buonfiglioli, Flavio Alessandrelli, Paolo Cecinato, Giuseppe Mazzella, Enrico Roda
Rosangela Muratori, Francesco Azzaroli, Federica Buonfiglioli, Flavio Alessandrelli, Paolo Cecinato, Giuseppe Mazzella, Enrico Roda, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9 - 40138 Bologna, Italy
Author contributions: Muratori R designed the study, performed the majority of experiments and wrote the paper; Azzaroli F and Buonfiglioli F performed the study and contributed to writing of the paper; Alessandrelli F and Cecinato P were involved in editing the manuscript; Mazzella G and Roda E revised the study.
Correspondence to: Dr. Rosangela Muratori, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9 - 40138 Bologna, Italy. rosangela.muratori@aosp.bo.it
Telephone: +39-51-6363733 Fax: +39-51-6363888
Received: February 16, 2010
Revised: April 1, 2010
Accepted: April 8, 2010
Published online: September 7, 2010
Abstract

AIM: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) for the management of refractory bile duct cholelithiasis in a third level referral centre.

METHODS: The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus, SIEMENS) from October 1990 to April 2005 were evaluated. All patients were monitored during the procedure and antibiotics were administered in case of cholangitis. The χ2 test and logistic regression analysis were performed as appropriate.

RESULTS: Two hundred and fourteen patients (102 males, 112 females; mean age 74.8 ± 0.84 years - single stone 97, multiple stones 117) underwent ESWL. The mean number of sessions and shock waves were 3.5 ± 0.13 and 3477.06 ± 66.17, respectively. The maximum stone size was 5 cm. Complete stone clearance was achieved in 192 (89.7%) patients. Of the remaining patients 15 required surgery, 2 a palliative stent and in 5 patients stone fragmentation led to effective bile drainage with clinical resolution despite incomplete clearance. Age, sex and stone characteristics were not related to treatment outcome. Major complications occurred in two patients (haemobilia and rectal bleeding) and minor complications in 25 (3 vomiting, 22 arrhythmias). No procedure-related deaths occurred.

CONCLUSION: ESWL is a safe and effective technique for clearance of refractory bile duct stones.

Keywords: Difficult bile duct stones, Extracorporeal shock wave lithotripsy