[Large calculi of the common bile duct. Value of lithotripsy]. / Calculs volumineux de la voie biliaire principale. Intérêt de la lithotritie.

ABSTRACT

Certain stones need to be fragmented before being extracted via endoscopic sphincterotomy (ES). From April 1988 to December 1991, extracorporeal lithotripsy was used in this indication in 28 patients (22 females, 6 males) with a mean age of 77 +/- 20 years, using an ultrasound-guided electrohydraulic lithotriptor. Stone detection was performed after perfusion of the nasogastric tube and was easy in 20 cases (71%), difficult in 6 cases (22%) and impossible in 2 cases (7%), which could not be treated by this method. The patients had an average of 1.4 +/- 0.9 stones measuring 19.6 +/- 8 mm and received an average of 2.480 +/- 580 shock waves in a single session for 24 patients and in two sessions for 2 patients. Radiologically obvious fragmentation was achieved in 11 out of 26 cases (42%) and was found to be effective at a further extraction attempt in 4 other cases. Complete clearance of the common bile duct was achieved in 15 cases (57.7%). The size of the stones (> or < 20 mm) and the solitary or multiple nature of the stones did not significantly influence the fragmentation results. No complication related to the technique was observed apart from the constant development of cutaneous petechiae. An improvement in the power of the generator and the use of fluoroscopic rather than ultrasonographic guidance should allow an improvement of these results in the future. Because of its safety, this lithotripsy method can be proposed following failure of mechanical lithotripsy.