Abstract
Over a 34-month period (1989-1991), 791 patients were diagnosed at endoscopic retrograde
cholangiography to have bile duct stones. All patients underwent sphincterotomy and
attempted extraction by Dormia basket. This was successful in 683 patients (86 %).
The remaining 108 patients with “difficult stones” (mean age 72 years) underwent mechanical,
electrohydraulic or extracorporeal shock wave lithotripsy according to the following
algorithm: (1) Mechanical lithotripsy for stones which could not be extracted after
entrapment in the Dormia basket (n = 33); (2) peroral cholangioscopic electrohydraulic
lithotripsy for stones which could not be engaged in the Dormia basket (n = 65); or
(3) extracorporeal shock wave lithotripsy for intrahepatic stones (n = 10). Stone
fragmentation and clearance was successful in all patients treated by mechanical lithotripsy,
was unsuccessful in one patient submitted to electrohydraulic lithotripsy due to inability
to insert the cholangioscope into the bile duct and failed in 3 patients treated by
extracorporeal shock wave lithotripsy. Overall, 95 % of difficult bile duct stones
refractory to conventional endoscopic basket extraction were removed using the above
lithotripsy techniques. There were no serious procedurerelated complications.