A comparative study of extracorporeal shock wave lithotripsy and cholangioscopy-guided lithotripsy in the management of complex biliary stones: A randomized trial.

Abstract

Large and impacted common bile duct stones (CBDSs) cannot be removed by conventional endoscopic retrograde cholangiopancreatography (ERCP), and extracorporeal shock wave lithotripsy (ESWL) or cholangioscopy-guided lithotripsy is recommended as a second-line treatment. The aim of this study is to compare safety and efficacy of ESWL for difficult CBDS. Patients at our hospital diagnosed with complex large CBDS between January 2021 and June 2022 were randomly assigned to the ESWL group or the cholangioscopy group for lithotripsy. Our results include clinical and technical success, the mean number of ERCP sessions, and any complications from the procedure. A total of 84 patients were included assigned to two groups (the ESWL group [42 patients] and the cholangioscopy group [42 patients]). Technical success was 92.85% for the ESWL group and 100% for the cholangioscopy group ( p = 0.19), whereas clinical success was 69% and 88%, respectively ( p = 0.01). The ESWL group had 2.32 ± 0.98 ERCPs, and the cholangioscopy group had 1.13 ± 0.36 ( p < 0.001). The mean lithotripsy sessions were 2.3 ± 0.63 for ESWL and 1.13 ± 0.36 for cholangioscopy ( p < 0.001). Both groups had similar adverse events, except for cutaneous petechiae. Compared with ESWL, cholangioscopy-guided lithotripsy is a safe and effective treatment for large and complex CBDSs. Therapeutic/Care Management; Level II.