Lithotripsy in the treatment of biliary stones.

Noninvasive or minimally invasive techniques for the treatment of biliary stones have been significantly advanced in the past two decades. The least invasive, extracorporeal shock-wave lithotripsy, continues to be used successfully, not only at its earliest reported site of use in Munich, Germany, but also in numerous other centers in the world. Lithotriptors that utilize a spark gap electrode or other sources of energy to generate sound waves and imaging by radiographic and ultrasonographic targeting of stones have proved to be effective in fragmenting biliary stones (90% to 95%) that are too large or otherwise inaccessible to removal by endoscopic papillotomy. Stone clearance (53% to 90%) may require successive treatments and the removal of debris by transendoscopic or surgical means. The mortality is low (0.5%), and the post-treatment course is relatively uncomplicated in an elderly, high-risk group of patients.