Electrohydraulic lithotripsy in the treatment of bile and pancreatic duct stones
- Isaac Raijman, MD
Isaac Raijman, MD
- Clinical Associate Professor of Medicine
- Baylor College of Medicine, Houston, TX
- Digestive Associates of Houston, PA
Electrohydraulic lithotripsy (EHL) is primarily used in the endoscopic fragmentation of difficult bile [1-15] and pancreatic duct stones [5,16,17]. It was originally used in the Soviet Union as an industrial tool for fragmentation of rocks. It was first used to treat bile duct stones in 1975 when it was performed through a T-tube tract using fluoroscopic guidance.
An advantage of EHL compared with other methods for treating difficult stones is that it is portable, rapid, efficient, and relatively inexpensive. EHL is typically used during peroral or percutaneous choledochoscopy or peroral pancreatoscopy. Because these techniques are not widely available, EHL is mostly used in tertiary centers with expertise in the endoscopic management of biliary tract disorders. (See "Cholangioscopy and pancreatoscopy".)
EHL has also been used for treatment of urinary tract stones, a setting where it has largely been replaced by other methods to achieve stone fragmentation (particularly Holmium laser lithotripsy). Laser lithotripsy for bile duct stones has not been widely adopted in part because of the costs and limited availability of equipment , but Holmium laser lithotripsy has been used successfully at various endoscopy centers, including ours, for the management of biliary and pancreatic stones . (See "Laser lithotripsy for the treatment of bile duct stones".)
This topic review will focus on the technical aspects and efficacy of EHL in the management of bile duct and pancreatic duct stones. Other methods for treating bile and pancreatic duct stones, including laser lithotripsy, extracorporeal shock wave lithotripsy, and standard mechanical lithotripsy, are discussed separately. (See "Laser lithotripsy for the treatment of bile duct stones" and "Extracorporeal shock wave lithotripsy for pancreatic stones" and "Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy".)
The principle of electrohydraulic lithotripsy (EHL) is the creation of an electric high-voltage spark between two isolated electrodes located at the tip of a fiber. The electric sparks are delivered in short pulses that create an immediate expansion of the surrounding liquid, inducing a spherical shock wave. The shock wave oscillates, generating sufficient pressure to fragment the stone. In vitro studies using chalk to simulate a stone and a 3.3 Fr probe have demonstrated that short pulses of high peak pressure provided by a low capacity and a high voltage have a greater impact on fragmentation than the corresponding broader shock waves of lower peak pressure carrying the same energy . Application of EHL is best achieved under direct visualization, since shock waves can also injure normal tissue.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Siegel JH, Ben-Zvi JS, Pullano WE. Endoscopic electrohydraulic lithotripsy. Gastrointest Endosc 1990; 36:134.
- Seitz U, Bapaye A, Bohnacker S, et al. Advances in therapeutic endoscopic treatment of common bile duct stones. World J Surg 1998; 22:1133.
- Binmoeller KF, Brückner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy 1993; 25:201.
- Lee JG, Leung JW. Endoscopic management of difficult common bile duct stones. Gastrointest Endosc Clin N Am 1996; 6:43.
- Craigie JE, Adams DB, Byme TK, et al. Endoscopic electrohydraulic lithotripsy in the management of pancreatobiliary lithiasis. Surg Endosc 1998; 12:405.
- Adamek HE, Schneider AR, Adamek MU, et al. Treatment of difficult intrahepatic stones by using extracorporeal and intracorporeal lithotripsy techniques: 10 years' experience in 55 patients. Scand J Gastroenterol 1999; 34:1157.
- Raijman I, Ankoma-Sey V, Monsour H, et al. The role of choledochoscopy in the diagnosis and management of non-transplant biliary tract disease. Hepatology 1997; 26:1829.
- Adamek HE, Maier M, Jakobs R, et al. Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy. Gastrointest Endosc 1996; 44:40.
- De Masi E, Lamazza A, Fiori E, et al. [Electrohydraulic intracorporeal lithotripsy in the treatment of "difficult" calculi of the common bile duct. Report of a caseload]. G Chir 1995; 16:452.
- Blind PJ, Lundmark M. Management of bile duct stones: lithotripsy by laser, electrohydraulic, and ultrasonic techniques. Report of a series and clinical review. Eur J Surg 1998; 164:403.
- Schumacher B, Frieling T, Haussinger D, Niederau C. Endoscopic treatment of symptomatic choledocholithiasis. Hepatogastroenterology 1998; 45:672.
- Hixson LJ, Fennerty MB, Jaffee PE, et al. Peroral cholangioscopy with intracorporeal electrohydraulic lithotripsy for choledocholithiasis. Am J Gastroenterol 1992; 87:296.
- Josephs LG, Birkett DH. Electrohydraulic lithotripsy (EHL) for the treatment of large retained common duct stones. Am Surg 1990; 56:232.
- Yucel O, Arregui ME. Electrohydraulic lithotripsy combined with laparoscopy and endoscopy for managing difficult biliary stones. Surg Laparosc Endosc 1993; 3:398.
- Sheen-Chen SM, Chou FF. Intraoperative choledochoscopic electrohydraulic lithotripsy for difficulty retrieved impacted common bile duct stones. Arch Surg 1995; 130:430.
- Tanaka M, Yokohata K, Kimura H, et al. Intraoperative endoscopic electrohydraulic lithotripsy of pancreatic stones. Int J Pancreatol 1992; 12:227.
- Howell DA, Dy RM, Hanson BL, et al. Endoscopic treatment of pancreatic duct stones using a 10F pancreatoscope and electrohydraulic lithotripsy. Gastrointest Endosc 1999; 50:829.
- DiSario J, Chuttani R, Croffie J, et al. Biliary and pancreatic lithotripsy devices. Gastrointest Endosc 2007; 65:750.
- Fishman DS, Tarnasky PR, Patel SN, Raijman I. Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. World J Gastroenterol 2009; 15:1353.
- Vorreuther R, Engelmann Y. Evaluation of the shock-wave pattern for endoscopic electrohydraulic lithotripsy. Surg Endosc 1995; 9:42.
- Arya N, Nelles SE, Haber GB, et al. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol 2004; 99:2330.
- Piraka C, Shah RJ, Awadallah NS, et al. Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones. Clin Gastroenterol Hepatol 2007; 5:1333.
- Cannavale A, Bezzi M, Cereatti F, et al. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience. Therap Adv Gastroenterol 2015; 8:340.
- Moon JH, Cha SW, Ryu CB, et al. Endoscopic treatment of retained bile-duct stones by using a balloon catheter for electrohydraulic lithotripsy without cholangioscopy. Gastrointest Endosc 2004; 60:562.
- Hui CK, Lai KC, Ng M, et al. Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Aliment Pharmacol Ther 2003; 17:289.
- Prachayakul V, Aswakul P, Kachintorn U. Electrohydraulic lithotripsy as an highly effective method for complete large common bile duct stone clearance. J Interv Gastroenterol 2013; 3:59.
- Papachristou GI, Baron TH. Endoscopic treatment of an impacted pancreatic duct stone using a balloon catheter for electrohydraulic lithotripsy without pancreatoscopy. J Clin Gastroenterol 2006; 40:753.
- Silver RI, Daniels MA, Rollins NK, et al. Percutaneous transhepatic endoscopic electrohydraulic lithotripsy of biliary tract calculi after orthotopic liver transplantation. J Laparoendosc Surg 1996; 6:357.
- Bourke MJ, Schneider DM, Haber GB. Electrohydraulic lithotripsy of a gallstone causing gallstone ileus. Gastrointest Endosc 1997; 45:521.
- Apel D, Jakobs R, Benz C, et al. Electrohydraulic lithotripsy treatment of gallstone after disimpaction of the stone from the duodenal bulb (Bouveret's syndrome). Ital J Gastroenterol Hepatol 1999; 31:876.