Choledocholithiasis and intrahepatic bile duct stones pose a significant health hazard, especially in the elderly.
The large stone not removable with conventional endoscopic techniques can be effectively and safely managed with electrohydraulic lithotripsy (EHL).
Dr Haber and colleagues from New York in America undertook a retrospective review of consecutive patients between October 1990 and March 2002 at the Wellesley Central Hospital and St. Michael's Hospital.
Participants underwent peroral endoscopic fragmentation of bile duct stones with electrohydraulic lithotripsy under direct cholangioscopic control using a "mother-baby" endoscopic system.
The researchers analyzed a total of 111 patients of which, 94 patients had complete records and were included in this study.
The investigators followed participants up for a mean time of 26.2 months.
Prior to EHL, 93 of 94 patients (99%) had endoscopic retrograde cholangiopancreatography (ERCP) and failed standard stone extraction techniques.
The researchers' performed EHL on those participants with large stones (81 patients) or a narrow caliber bile duct below a stone of average size (13 patients).
The research team managed to achieve successful fragmentation (61 complete, 28 partial) in 96% of patients.
|76% of patients required 1 EHL session, 14% required 2 sessions, and 10% required 3 or more|
|American Journal of Gastroenterology|
The researchers excluded 1 patient was excluded from analysis due to a broken endoscope.
Fragmentation failures were due to targeting problems (2 patients) and hard stones (2 patients).
The researchers noted that 76% of patients required 1 EHL session, 14% required 2 sessions, and 10% required 3 or more.
The research group found that all patients with successful stone fragmentation required post-EHL balloon or basket extraction of fragments.
During the study, the researchers observed such complications as: cholangitis and/or jaundice (13 patients); mild hemobilia (1 patient); mild post-ERCP pancreatitis (1 patient); biliary leak (1 patient); and bradycardia (1 patient).
There were no deaths related to EHL.
The investigators achieved a final stone clearance 90% of patients.
Dr Haber concluded, "EHL via peroral endoscopic choledochoscopy is a highly successful and safe technique for use in the management of difficult choledocholithiasis and intrahepatic stones."
"This study has shown a stone fragmentation rate of 96%, and a final stone clearance rate of 90%."