Extracorporeal shock-wave lithotripsy for retained common bile duct stones

Retained common bile duct stones (CBDS) become a challenging problem when percutaneous and endoscopic methods fail. Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive and effective treatment modality, and can be used as an alternative treatment of retained CBDS. We report our experience with 20 patients who had retained CBDS, using a second-generation electromagnetic lithotriptor. Thirteen patients who had cholecystectomy and common bile duct exploration, with stone extraction and T-tube drainage, were in the early postoperative period. Seven patients had undergone previous endoscopic sphincterotomy and nasobiliary drainage. Fourteen patients had only one ESWL session. Stone fragmentation rates were 100% and 57% in patients with T-tube and nasobiliary catheter, respectively. The overall stone fragmentation rate was 85% and complete stone clearance was achieved in all these patients (85%). Complications were mild and relatively infrequent (20%). There was no mortality. We conclude that ESWL for retained CBDS is a safe, effective and minimally-invasive treatment modality. ESWL should be considered as a significant alternative to surgery when endoscopic and percutaneous treatment modalities are not successful