Multidisciplinary Management of Common Bile Duct Stones by Jeffrey W. Hazey Darwin L. Conwell & Gregory E. Guy

Author:Jeffrey W. Hazey, Darwin L. Conwell & Gregory E. Guy
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Mechanical Lithotripsy

Mechanical lithotripsy has become the international standard after ES for the treatment of non-extractable bile duct stones, particularly those smaller than 2.8 cm [14], although EPLBD has been gaining acceptance as an alternative in the gastroenterology community (see above). Mechanical lithotripsy uses physical force to break stones into smaller pieces, facilitating extraction (Fig. 10.4). The success rate of ES and mechanical lithotripsy is 90–97 % if the stone can be captured by the basket [1]. Reasons for failure of mechanical lithotripsy include inability to grasp the stone, minimal fragmentation, abnormal bile duct configuration, and misshapen baskets or failure to deploy the basket [15]. Other uncommon reasons for failure include breakage of the basket inside the bile duct and inability to break the stone. Currently, baskets with built-in breaking points are used to avoid basket impaction/trapping inside the common bile duct. A retrospective review of 643 cases of biliary mechanical lithotripsy done in seven expert centers reported a complication rate of 3.6 % [16]. Most of the complications were managed endoscopically, and only one patient required surgery.

Fig. 10.4Lithotripsy basket

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