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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones
Tao Tao, Ming Zhang, Qi-Jie Zhang, Liang Li, Tao Li, Xiao Zhu, Ming-Dong Li, Gui-Hua Li, Shu-Xia Sun
Tao Tao, Qi-Jie Zhang, Ming-Dong Li, Gui-Hua Li, Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Ming Zhang, Department of Rehabilitation, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Liang Li, Department of General Surgery (Breast and Thyroid Surgery), Zibo Central Hospital, Zibo 255000, Shandong Province, China
Tao Li, Department of Orthopedics (Spinal Surgery), Zibo Central Hospital, Zibo 255000, Shandong Province, China
Xiao Zhu, Guangdong Province Key Laboratory of Medical Molecular Diagnosis, Guangdong Medical College, Dongguan 523808, Guangdong Province, China
Shu-Xia Sun, Department of Gynecology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Author contributions: Tao T designed the study and performed the majority of experiments; Zhang M, Zhu X and Zhang QJ provided analytical tools and were also involved in editing the manuscript; Li L, Li T, Li MD, Li GH and Sun SX co-ordinated and provided the collection of experimental data.
Institutional review board statement: The study was reviewed and approved by the Zibo Central Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tao Tao, MD, PhD, Department of Gastroenterology, Zibo Central Hospital, 54 Gongqingtuan Road, Zibo 255000, Shandong Province, China.
songlin7189@163.com
Telephone: +86-533-2360539 Fax: +86-533-2360539
Received: March 15, 2017
Peer-review started: March 17, 2017
First decision: April 20, 2017
Revised: May 3, 2017
Accepted: June 9, 2017
Article in press: June 12, 2017
Published online: July 21, 2017
Processing time: 126 Days and 13 Hours
AIM
To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs 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% vs 71.0%, P = 0.135), but a higher clearance rate within the second treatment session (84.4% vs 51.6%, P = 0.018) and total stone clearance (96.0% vs 86.0%, P = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min vs 59 ± 28 min, P = 0.034) and the rate of mechanical lithotripsy use (20% vs 30%, P = 0.025), but also raised the clearance rate of extremely large stones (80.0% vs 40.0%, P = 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.
Core tip: Extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) are frequently used for patients with large common bile duct (CBD) stones. The effect of a session of ESWL prior to ERCP for problematic and large CBD stones has not previously been reported. The results of our research suggested that a session of ESWL can aid clearance of CBD in the following ERCP. Also mechanical lithotripsy usage was reduced and extremely large stone (≥ 30 mm) clearance rate can be raised.
