RT Journal Article SR Electronic T1 Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy JF Gut JO Gut FD BMJ Publishing Group Ltd and British Society of Gastroenterology SP 728 OP 731 DO 10.1136/gut.47.5.728 VO 47 IS 5 A1 R D Ellis A1 A P Jenkins A1 R P H Thompson A1 R J Ede YR 2000 UL http://gut.bmj.com/content/47/5/728.abstract AB BACKGROUND Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.AIMS To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.METHODS Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.RESULTS Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.CONCLUSION Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.ESWLextracorporeal shockwave lithotripsyERCPendoscopic retrograde cholangiopancreatographyECGelectrocardiogram