A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave.

BACKGROUND: When conventional endoscopic treatment of bile duct stones is impossible or fails, advanced endoscopy-assisted lithotripsy can be performed by electrohydraulic lithotripsy (EHL), laser lithotripsy, or extracorporeal shock wave lithotripsy (ESWL). No systematic review has compared efficacy and safety between these techniques. METHODS: A systematic search was performed in PubMed, the Cochrane Library, and EMBASE for studies investigating EHL, laser lithotripsy, and ESWL in patients with retained biliary tract stones. RESULTS: After screening 795 studies, 32 studies with 1969 patients undergoing EHL (n = 277), laser lithotripsy (n = 426) or ESWL (n = 1266) were included. No randomized studies were available. Although each advanced lithotripsy technique appeared to be highly effective, laser lithotripsy had a higher complete ductal clearance rate (95.1 %) than EHL (88.4 %) and ESWL (84.5 %; P  < 0.001). In addition, a higher stone fragmentation rate was reported for laser lithotripsy (92.5 %) than for EHL (75.5 %) and ESWL (89.3 %; P < 0.001). The post-procedural complication rate was significantly higher for patients treated with EHL (13.8 %) than for patients treated with ESWL (8.4 %) or laser lithotripsy (9.6 %; P = 0.04). Data on the recurrence rate of the biliary tract stones were lacking. CONCLUSION: This systematic review revealed that laser lithotripsy appeared to be the most successful advanced endoscopy-assisted lithotripsy technique for retained biliary tract stones, although randomized studies are lacking.

[The principle of extracorporeal shock wave lithotriptor and its locating system].

This article describes in detail the classification of extracorporeal shock wave lithotriptors, charging and discharging circuit of shock wave, wave source and the locating system of the lithotriptor, makes a comparison between three kinds of conventional shock wave sources, and analyzes the advantages and shortcomings of the different locating systems.

Gastroenterology and urology devices; reclassification of the extracorporeal shock wave lithotripter. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to reclassify from class III to class II the extracorporeal shock wave lithotripter, when intended for use to fragment kidney and ureteral calculi. FDA is taking this action on its own initiative in order to assure that these devices are regulated according to the appropriate degree of regulatory control needed to provide reasonable assurance of their safety and effectiveness.

[Extracorporeal shockwave lithotripsy. A brief review of the types of equipment currently in use]. / La lithotripsie extra-corporelle par ondes de choc (LECOC). Revue abrégée des types d'appareils actuellement en usage

Presentation of the main lithotriptors used in 1996: Dornier HM3 and 4, Edap-Technomed Sonolith, Storz Modulith, Siemens Lithostar, Wolf. Comparison of the efficacy coefficients of these apparatuses.

Manejo de la urolitiasis con litotripsia extracorpórea por ondas de choque / Management of urolithiasis with extracorporeal short-wave lithotripsy

La litotripsia extracorpórea por ondas del choque (LEC) es un abordaje terapéutico utilizado para el tratamiento de la urolitiasis. Las ondas de choque son frentes de energía que siendo enfocadas sobre un cálculo producen su fragmentación al rebasar las fuerzas de cohesión que lo mantienen integro. La LEC fue intraducida en febrero de 1980 tras diez años de investigación en los que se definieron las características de la onda, su bioefectos y las diferentes formas de producición y enfoque. La introducción de la LEC ha causado tal impacto que el procedimiento es exitoso como monoterapia en un 70 por ciento y combinado con nefroliototomía percutánea en un 95 por ciento de las litiasis renales. En la Fundación Santafé de Bogotá se introdujo el procedimiento en junio de 1989 y hemos obtenido éxito en el 93.6 por ciento de nuestros pacientes.

[An overview of extracorporeal lithotriptors in current clinical use: technical notes]. / Panoramica sui litotritori extracorporei attualmente in uso clinico: note techniche.

ASWL ten years ago opened a new era for kidney stone treatment and recently it's showing a new therapeutical approach to biliary stones. Dornier HM3 is since 1983 the first lithotripter with a wide clinical employment. Actually we know about twenty extracorporeal lithotripter in clinical use. Our review try to classify old and new extracorporeal lithotripsy devices looking at technical aspects and lithotripsy center organization.