Forecasting and Retreatment of Unsuccessful Endoscopic Mechanical Lithotripsy in Patients with Difficult Bile Duct Stones

Lee, Sang Hyub; Park, Joo Kyung; Yoon, Won Jae; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong Tae; Yoon, Yong Bum

Abstract

BACKGROUND/AIMS
Endoscopic removal of a bile duct stone becomes more difficult with increasing stone size. The endoscopic mechanical lithotripsy is frequently used to overcome this problem. However, it is necessary to predict its outcome and determine the optimal treatment when it does fail. This study examined the predictors and optimal treatment for an unsuccessful endoscopic mechanical lithotripsy.
METHODS
One hundred and twenty five patients who underwent endoscopic mechanical lithotripsy, were retrospectively evaluated. Various predictive factors and procedure-related complications were analyzed. In addition, the clinical outcome of retreatment for unsuccessful endoscopic mechanical lithotripsy was evaluated.
RESULTS
Endoscopic mechanical lithotripsy was successful in 97 patients (77.6%). An impacted stone(s), stone size (> or =30 mm) and stone size/bile duct diameter (> 1.0) were significant factors forecasting failure, with an estimated odds ratio 26.67, 5.94 and 5.99, respectively. More frequent complications related with the failure were not observed. When the procedure did fail, all were retreated successfully with various modalities including surgery. Despite the short hospitalization period, non-surgical treatment had a similar clinical outcome to that of surgery.
CONCLUSIONS
An impacted stone, stone size (> or = 30 mm) or stone size/bile duct diameter (> 1.0) in difficult choledocholithiasis are indicators of unsuccessful endoscopic mechanical lithotripsy. Alternative non-surgical treatment might be considered to manage difficult choledocholithiasis when endoscopic mechanical lithotripsy fails.