SWL literature
Slider

Tao T et al, 2017: Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones.

Tao T, Zhang M, Zhang QJ, Li L, Li T, Zhu X, Li MD, Li GH, Sun SX.
Tao Tao, Qi-Jie Zhang, Ming-Dong Li, Gui-Hua Li, Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China.

Abstract

AIM: To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs ERCP only for problematic and large common bile duct (CBD) stones.
METHODS: Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups, an "ESWL + ERCP group" and an "ERCP-only" group. For ESWL + ERCP cases, ESWL was performed prior to ERCP. Clearance of the CBD, complications related to the ESWL/ERCP procedure, frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.
RESULTS: There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session (74.2% vs 71.0%, P = 0.135), but a higher clearance rate within the second treatment session (84.4% vs 51.6%, P = 0.018) and total stone clearance (96.0% vs 86.0%, P = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min vs 59 ± 28 min, P = 0.034) and the rate of mechanical lithotripsy use (20% vs 30%, P = 0.025), but also raised the clearance rate of extremely large stones (80.0% vs 40.0%, P = 0.016). Post-ERCP complications were similar for the two groups.
CONCLUSION: Based on the higher rate of successful stone removal and minimal complications, ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.

World J Gastroenterol. 2017 Jul 21;23(27):4950-4957. doi: 10.3748/wjg.v23.i27.4950.

 

0
 

Comments 1

Hans-Göran Tiselius on Monday, 18 December 2017 08:37

Removal of bile duct stones can be a very complicated and challenging task. Although is a non-urological problem, the requests by endoscopists to use SWL as a complement to ERCP commonly is placed in the hands of those urologists who are responsible for SWL-service in the hospital.
It accordingly is reassuring that the combined use of SWL and ERCP for removal of large and difficult-to-treat bile duct stones resulted in a better outcome particularly when extremely large stones were considered. As indicated by the shorter duration of the procedure, SWL obviously facilitated the ERCP procedure.
It is of note that the authors emphasize the importance of complete stone fragment clearance and recommend saline irrigation.
The reported rate of usually mild complications was low.
The same technique was used successfully already in the early 1990th [1] and open surgery for this kind of problems most certainly is required only exceptionally.
Reference
1. Lindström E, Borch K, Kullman EP, Tiselius HG, Ihse I.
Extracorporeal shock wave lithotripsy of bile duct stones: a single institution experience.
Gut. 1992 Oct;33(10):1416-20.

Removal of bile duct stones can be a very complicated and challenging task. Although is a non-urological problem, the requests by endoscopists to use SWL as a complement to ERCP commonly is placed in the hands of those urologists who are responsible for SWL-service in the hospital. It accordingly is reassuring that the combined use of SWL and ERCP for removal of large and difficult-to-treat bile duct stones resulted in a better outcome particularly when extremely large stones were considered. As indicated by the shorter duration of the procedure, SWL obviously facilitated the ERCP procedure. It is of note that the authors emphasize the importance of complete stone fragment clearance and recommend saline irrigation. The reported rate of usually mild complications was low. The same technique was used successfully already in the early 1990th [1] and open surgery for this kind of problems most certainly is required only exceptionally. Reference 1. Lindström E, Borch K, Kullman EP, Tiselius HG, Ihse I. Extracorporeal shock wave lithotripsy of bile duct stones: a single institution experience. Gut. 1992 Oct;33(10):1416-20.
Guest
Tuesday, 15 October 2019
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com