Efficacy of Real Time US Guided ESWL for Bile Duct Stones

  • Dr Katsuyuki Koichi, Department of Internal Medicine, Asanogawa General Hospital, Japan
  • Dr Ichiro Araki, Department of Internal Medicine, Asanogawa General Hospital, Japan
  • Dr Naomichi Hamano, Department of Internal Medicine, Asanogawa General Hospital, Japan
  • Dr Toshio Ueno, Department of Internal Medicine, Asanogawa General Hospital, Japan
  • Mr Susumu Motoji, Unit of Clinical Ultrasound, Asanogawa General Hospital, Japan

    • Purpose: Real time US guided ESWL was performed in patients with bile duct stones to evaluate its efficacy and safety .
    Methods: 100 patients with bile duct stones were treated with real time US guided ESWL. Before ESWL, conventional ultrasonic examinations were performed on prone position to see the number, the size and the character of stones. To visualize common bile duct more easily on US, a small amount of water (50-100ml) was taken to patients. Using machines were HDI-3000 (ATL) and EUB-8500 (HITACHI) for observation, and MPL-9000 (Dornier) for ESWL.
    Results: Bile duct stones were visualized on US in almost all patients because the prone position with water intake enabled us to make acoustic window by water in gasric antrum. The average number of shock waves required was 3658 (350-27985). The number of stones was 1 to 13 and the size 5 to 55 mm. Stone disintegration was achieved in 88 (88%) of 100 patients and its clearance rate was 78% after 2 weeks from ESWL. After all, clearance rate was raised to 94% by additional treatments such as endoscopic or percutaneous radiologic intervention for fragment extraction. Only minor complications occurred in and after treatment which were arrythmia (11%), fever (4%), macroscopic hematuria (3%) and abdominal pain (2%).
    Conclusion: Real time US guided ESWL was very effective in patients with bile duct stones and may be more safe and non-invasive than X-ray guided ESWL.