Electrohydraulic lithotripsy as an highly effective method for complete large common bile duct stone clearance

Abstract

The removal of common bile duct (cBD) stones is commonly performed by endoscopic retrograde cholangiography (eRc), which has an 85-90% success rate. Thus, 10-15% of cBD stones, specifically large ones, cannot be completely removed using standard techniques and are therefore managed conservatively by sequential biliary stenting or using other techniques such as electrohydraulic lithotripsy (ehL). The aim of the present paper was to determine the outcomes of these different methods for the removal of large cBD stones in the patients who failed to clear the cBD after initial attempt and to identify the factors which might associated with patients who would fail for sequential biliary stenting. We retrospectively reviewed 439 patients who underwent eRc for stone removal in our institute. In this study, 36 cases and 7 cases were included in the sequential biliary stenting and intraductal ehL groups, respectively, with rates of complete cBD clearance of 86.1% and 100%, respectively. On average, 2.8 and 1.3 sessions were required before complete stone removal in the biliary stenting and ehL groups, respectively. The number of complications during follow-up was higher in biliary stenting than in intraductal ehL patients. The factors associated with failure to complete cBD stone clearance in the biliary stenting group were no change in cBD stone size 9 weeks after the first biliary stenting attempt and failure of balloon sphincteroplasty. ehL was an effective and safe procedure for acheivement of complete cBD clearance especially for large cBD stone.