Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones |
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Authors: | C Harz T O Henkel K U Köhrmann F Pimentel P Alken B C Manegold |
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Institution: | 1. Abteilung für Endoskopie, Fakult?t für Klinische Medizin der Universit?t Heidelberg, Postfach 23, W-6800, Mannheim 1, Federal Republic of Germany 2. Abteilung für Urologie, Klinikum der Stadt Mannheim, Fakult?t für Klinische Medizin der Universit?t Heidelberg, Postfach 23, W-6800, Mannheim 1, Federal Republic of Germany
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Abstract: | Summary Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy
and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy.
When stone removal was not possible, patients were subjected to ESWL, Fragmented stones were removed endoscopically. During
1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically.
In all, 3 subjects received alternative treatmenl and the remaining 29 (13%) constituted our study group: 19 (65%) were women
and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis
at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications
were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association
of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open
surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous
cholecystectomy. |
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Keywords: | Bile duct stones ESWL Endoscopy |
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