RESUMO
BACKGROUND: When conventional endoscopic treatment of bile duct stones is impossible or fails, advanced endoscopy-assisted lithotripsy can be performed by electrohydraulic lithotripsy (EHL), laser lithotripsy, or extracorporeal shock wave lithotripsy (ESWL). No systematic review has compared efficacy and safety between these techniques. METHODS: A systematic search was performed in PubMed, the Cochrane Library, and EMBASE for studies investigating EHL, laser lithotripsy, and ESWL in patients with retained biliary tract stones. RESULTS: After screening 795 studies, 32 studies with 1969 patients undergoing EHL (nâ=â277), laser lithotripsy (nâ=â426) or ESWL (nâ=â1266) were included. No randomized studies were available. Although each advanced lithotripsy technique appeared to be highly effective, laser lithotripsy had a higher complete ductal clearance rate (95.1â%) than EHL (88.4â%) and ESWL (84.5â%; P â<â0.001). In addition, a higher stone fragmentation rate was reported for laser lithotripsy (92.5â%) than for EHL (75.5â%) and ESWL (89.3â%; Pâ<â0.001). The post-procedural complication rate was significantly higher for patients treated with EHL (13.8â%) than for patients treated with ESWL (8.4â%) or laser lithotripsy (9.6â%; Pâ=â0.04). Data on the recurrence rate of the biliary tract stones were lacking. CONCLUSION: This systematic review revealed that laser lithotripsy appeared to be the most successful advanced endoscopy-assisted lithotripsy technique for retained biliary tract stones, although randomized studies are lacking.