World Congress of Gastroenterology

WCOG 2019


 
EFFICACY AND SAFETY OF EXTRACORPOREAL SHOCK-WAVES LITHOTRIPSY IN BILIARY AND PANCREATIC STONES: A 12-YEARS EXPERIENCE
FRANCESCO DECEMBRINO 1 SIMONE GRILLO 1 LORENZO CAMELLINI 2 FRANCESCO AZZOLINI 3 CRISTIANA TIOLI 1 VERONICA IORI 1 GIULIANA SERENI 1 MAURIZIO CAVINA 1 PAOLO CECINATO 1 FRANCESCA PARMEGGIANI 1 ROMANO SASSATELLI 1

1- IRCCS-AUSL REGGIO EMILIA
2- ASL 5 - LA SPEZIA
3- OSPEDALE VITA SALUTE SAN RAFFAELE
 
Background/Aims:

Biliary and pancreatic stones are often removed endoscopically by ERCP in case of jaudice, cholangitis, chronic pancreatitis. When it is impossibile because of their dimension or challenging position, extracorporeal shock-waves lithotripsy is an option for their treatment since some years, but it isnĀ“t widespread in gastroenterology departments.

Materials and Methods:

We aimed to assess efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in patients with large biliary and pancreatic stones. From January 2007 to December 2018 in our center we performed ESWL in 106 patients, 57 males and 49 females, (median age 72,8 years, range 35-98 years) for refractory bile duct (95 patients) and pancreatic (11 patients) stones refractory to ERCP, even associated to endoscopic mechanical lithotripsy. The 82,1% of patients underwent a single session of ESWL, the others 2 or more sessions. The 50%, 13,5% and 36.5% of patients had respectively 1, 2 and 3 or more stones. The median diameter of the stones was 25.3 mm (range 10-50 mm) and 18.9% of them were located upstream of a stricture. As for biliary stones, 80% were extrahepatic (including localization in hepatic and cystic duct), 16.8% intrahepatic, 3.2% both.

Results:

Overall the fragmentation of the stones was obtained in 83 out of 106 patients (78.3%), with a complete clearance in 76,4%. Considering only biliary stones, the clearance rate (CR) increased to 80%, with a significant difference (p=0.03) between patients with 1 or 2 stones (CR = 88%) and those with 3 or more stones (CR = 69%). Most patients with 1 or 2 stones (92%) underwent ESWL once, while a single session was performed only in the 73.5% of patients with 3 or more stones (p=0.018). The 89,5% of the complete clearance was obtained with a single session of ESWL, the remainig 10,5% needed 2 or more sessions. As for safety, intraprocedural hemobilia was reported only for 5 out of 106.

Conclusion:

Extracorporeal shock-waves lithotripsy is an effective and safe technique to remove biliary and pancreatic stones. The presence of a single stone in the biliary tree can be predictive of a successful ESWL in a single session.

Keywords:

Large biliary stones, chronic pancreatitis, ESWL, complete clearance