Endoscopic Mechanical Lithotripsy Research Articles

Endoscopic mechanical lithotripsy of difficult common bile duct stones

Endoscopic mechanical lithotripsy of difficult common bile duct stones

Endoscopic sphincterotomy and mechanical basket lithotripsy for management of difficult common bile duct stones

Endoscopic sphincterotomy (EST) for removal of stones is a major therapeutic advance in the management of choledocholithiasis. However, this technique, using a standard Dormia basket or balloon catheters, often fails with large stones (exceeding 15mm in diameter). Mechanical basket lithotripsy (MBL) has been developed to overcome this deficiency. With recently improved devices, consisting of an entirely, i.e., one self-contained system which can be used without removing the endoscope, the overall efficacy of stone removal is more than 93%, regardless of the size of the stones. This MBL is a simple, safe, effective and inexpensive procedure in experienced hands and has emerged as the procedure of choice for endoscopic management of difficult stones.

Mechanical lithotripsy of large common bile duct stones.

Endoscopic removal of biliary calculi is a safe and effective alternative to surgical exploration of the common bile duct. However, as stones increase in diameter, endoscopic retrieval becomes more difficult and hazardous. Mechanical lithotripsy is an endoscopic technique used to crush common bile duct stones that are too large to be removed by conventional methods. In the 3 years following the introduction of this technique at our institution, 145 patients underwent endoscopic retrograde cholangiopancreatography for symptomatic choledocholithiasis. Endoscopic mechanical lithotripsy improved the overall success rate of common bile duct clearance from 86.2% to 94.5%. No morbidity or mortality was associated with the procedure. Therefore, we recommend mechanical lithotripsy when bile duct stones cannot be removed with conventional techniques.

Methyltert-butyl ether in the endoscopic treatment of common bile duct radiolucent stones in elderly patients with nasobiliary tube

Methyl tert-butyl ether is an effective dissolution agent for cholesterol stones. The aim of this work was to evaluate the effect of methyl tert-butyl ether on radiolucent common bile duct stones in patients in whom endoscopic extraction has failed. From September 1985 to September 1987, 1374 patients underwent endoscopic retrograde cholangiopancreatography in our Liver Unit. An endoscopic sphincterotomy was indicated in 195 patients with common bile duct (CBD) stones because of an age over 65 years and/or surgical contraindications. Endoscopic sphincterotomy was efficient in 187 patients, allowing complete stone removal in association with conventional endoscopic methods and mechanical lithotripsy in 170 patients. Twelve of the 17 patients with failure of conventional endoscopic treatments were either older than 75 years (11 patients; mean age, 86 +/- 4.5 years) or exhibited a surgical contraindication. Stones completely obstructed CBD in six patients and had a diameter exceeding 25 mm in the six other patients. These subjects were selected for stone dissolution by methyl tert-butyl either (MTBE) according to the following protocol. MTBE was directly infused into CBD through a nasobiliary catheter, twice daily for 4-13 days (mean, seven days). Bile duct opacification, repeated after MTBE treatment, revealed the complete disappearance of CBD stones in one patient, a decrease in stone size in five patients and no change in the six other patients. MTBE treatment was well tolerated except in three patients who complained from transient abdominal pains and nausea. At the second attempt of endoscopic treatment, CBD stones were found to be softened and easily broken up, allowing a complete clearance in six patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Large-bile-duct stones ? extracorporeal piezoelectric lithotripsy as adjuvant measure for endoscopic basket extraction

Extracorporeal piezoelectric lithotripsy (EPL) was performed in 12 patients with large-bile-duct stones and intrahepatic stones. The Piezolith 2300 lithotripter (Wolf, Knittlingen, FRG) was used in all patients in whom routine endoscopic approaches for removal of the calculi had failed or were considered inappropriate because of large stone size or difficult localization. In 9 of the 12 patients the stones were fragmented. Complete stone clearance from the bile ducts was obtained in 8 of 10 patients by EPL alone or combined with one of the following: endoscopic extraction, mechanical lithotripsy or installation of solvents. Adjuvant EPL in conjunction with endoscopic therapy increased the success rate of nonsurgical treatment for bile duct stones from 73% to 95%. No clinically significant side effects or complications were noted.

Endoscopic mechanical lithotripsy for the treatment of common bile duct stone. Experience with the improved double sheath basket catheter.

Using a newly designed basket catheter, endoscopic mechanical lithotripsy was attempted in 14 patients with common bile duct stones following endoscopic sphincterotomy, and was successful in all cases. Endoscopic mechanical lithotripsy is a supplementary means of removing common bile duct stones after endoscopic sphincterotomy, and its usefulness is highly rated. In some cases, however, there is difficulty in inserting the basket catheter into the common bile duct and grasping the gallstone. The newly designed forceps was accordingly developed, to smash these bile duct stone more reliably and effectively.

Endoscopic removal of common bile duct stones through the intact papilla after medical sphincter dilation

Recently, glyceryl trinitrate was shown to effectively dilate the smooth muscle of the sphincter of Oddi. This information was applied to endoscopic therapy of bile duct stones. In 21 patients a total of 32 common bile duct stones, 6–12 mm ( x¯ = 8.7 mm) in diameter, were removed through the intact sphincter after its medical dilation by administration of 1.2–3.6 mg glyceryl trinitrate. Thirty of 32 stones could be extracted without difficulty. The remaining two concrements had to be crushed by endoscopic mechanical lithotripsy before removal. No complications were observed during or after the procedure. Follow-up manometric examinations showed the papillary function to be well preserved. We therefore consider this new, safe, and easy method to be the treatment of choice for the removal of small- and medium-sized bile duct stones.