Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones.

Aim: To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) ERCP only for problematic and large common bile duct (CBD) stones.

Methods: Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups, an "ESWL + ERCP group" and an "ERCP-only" group. For ESWL + ERCP cases, ESWL was performed prior to ERCP. Clearance of the CBD, complications related to the ESWL/ERCP procedure, frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.

Results: There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session (74.2% 71.0%, = 0.135), but a higher clearance rate within the second treatment session (84.4% 51.6%, = 0.018) and total stone clearance (96.0% 86.0%, = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min 59 ± 28 min, = 0.034) and the rate of mechanical lithotripsy use (20% 30%, = 0.025), but also raised the clearance rate of extremely large stones (80.0% 40.0%, = 0.016). Post-ERCP complications were similar for the two groups.

Conclusion: Based on the higher rate of successful stone removal and minimal complications, ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.