Endoscopic retrograde cholangiopancreatography combined with extracorporeal shock wave lithotripsy in treating intractable choledocholithiasis with huge bile ductal stones in elderly patients

Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL) in treating intractable choledocholi-thiasis with huge bile ductal stones in elderly patients. Methods 46 patients were diagnosed with intractable choledocholithiasis with huge bile ductal stones by ERCP. Integrated nasobiliary and pancreatic stents were placed initially. A second ERCP was performed to remove fragmented stones after ESWL. Results The average number and diameter of bile ductal stones were 1.8 (1~4) and 2.6 cm (2.0~3.2), respectively. All patients successfully underwent ERCP and no ERCP-related complications occurred. The average shock wave energy, frequency and duration of treatment were 24.2 J (20.0~45.0), 4 348 times (3 000~5 000) and 3.2 courses (1~7). All large common bile ductal stones were fragmented into stones with a dia-meter of less than 1cm. There were 2 patients who developed acute cholecystitis, 4 patients acute cholangitis and 2 patients hemobilia after ESWL. One patient was treated with percutaneous transhepatic gallbladder drainage for acute obstructive suppurative cholecystitis and the remaining patients were treated by medical treatment and biliary irrigation through the nasobiliary tube. The fragmented stones in the common bile ducts were removed by a second ERCP. There was no respiratory failure, heart failure, death or any other severe complications. Conclusion ERCP combined with ESWL was a safe and effective treatment for intractable choledocholithiasis with huge bile ductal stones in elderly patients. Key words: Endoscopic retrograde cholangiopancreatography; Extracorporeal shock wave lithotripsy; Choledocholithiasis; Pancreatic stent; Endoscopic nasobiliary drainage; Elderly patients