BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) for difficult common bile duct (CBD) stones is a safe and effective treatment strategy allowing for bile duct clearance in approximately 90% of patients with a low incidence of mild adverse events. OBJECTIVE: To compare the CBD clearance rates achieved after ESWL performed with 2 different lithotripters (Siemens Lithostar Plus and Storz Modulith SLX-F2) in a large cohort of patients with difficult CBD stones. DESIGN: A retrospective analysis of a prospectively collected database. SETTING: Tertiary care center. PATIENTS: All of the consecutive patients who underwent ESWL because of difficult CBD stones between 1990 and 2012 were considered suitable for inclusion. INTERVENTIONS: ESWL with Lithostar Plus or with Modulith SLX-F2. MAIN OUTCOME MEASUREMENTS: CBD clearance. RESULTS: Three hundred ninety-two patients with difficult CBD stones were treated; 199 patients were treated with the Lithostar Plus and 193 patients with the Modulith SLX-F2. CBD clearance was achieved in 349 patients (89.0%) with no significant difference between the patients treated with Lithostar Plus and those treated with Modulith SLX-F2 (90.5% vs 87.6%; P = .45). Patients treated with Modulith SLX-F2 underwent a significantly lower number of ESWL sessions (3 [range, 2 to 4] vs 3 [range, 2 to 4]; P = .0015), had a lower incidence of ESWL-related adverse events (5.2% vs 13.6%; P = .009), and never required opioid analgesia (P < .001). LIMITATIONS: Retrospective design. CONCLUSIONS: The Modulith SLX-F2 allows the same clearance rate as the Lithostar Plus but has a significantly lower incidence of adverse events and requires fewer ESWL sessions.
BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) for difficult common bile duct (CBD) stones is a safe and effective treatment strategy allowing for bile duct clearance in approximately 90% of patients with a low incidence of mild adverse events. OBJECTIVE: To compare the CBD clearance rates achieved after ESWL performed with 2 different lithotripters (Siemens Lithostar Plus and Storz Modulith SLX-F2) in a large cohort of patients with difficult CBD stones. DESIGN: A retrospective analysis of a prospectively collected database. SETTING: Tertiary care center. PATIENTS: All of the consecutive patients who underwent ESWL because of difficult CBD stones between 1990 and 2012 were considered suitable for inclusion. INTERVENTIONS: ESWL with Lithostar Plus or with Modulith SLX-F2. MAIN OUTCOME MEASUREMENTS: CBD clearance. RESULTS: Three hundred ninety-two patients with difficult CBD stones were treated; 199 patients were treated with the Lithostar Plus and 193 patients with the Modulith SLX-F2. CBD clearance was achieved in 349 patients (89.0%) with no significant difference between the patients treated with Lithostar Plus and those treated with Modulith SLX-F2 (90.5% vs 87.6%; P = .45). Patients treated with Modulith SLX-F2 underwent a significantly lower number of ESWL sessions (3 [range, 2 to 4] vs 3 [range, 2 to 4]; P = .0015), had a lower incidence of ESWL-related adverse events (5.2% vs 13.6%; P = .009), and never required opioid analgesia (P < .001). LIMITATIONS: Retrospective design. CONCLUSIONS: The Modulith SLX-F2 allows the same clearance rate as the Lithostar Plus but has a significantly lower incidence of adverse events and requires fewer ESWL sessions.
Authors: Rabindra R Watson; Mansour A Parsi; Harry R Aslanian; Adam J Goodman; David R Lichtenstein; Joshua Melson; Udayakumar Navaneethan; Rahul Pannala; Amrita Sethi; Shelby A Sullivan; Nirav C Thosani; Guru Trikudanathan; Arvind J Trindade; John T Maple Journal: VideoGIE Date: 2018-09-26