Effectivity of Extracorporeal Shock Wave Lithotripsy and Stenting vs Stenting Only for Difficult Common Biliary Duct Stones: A Retrospective Analysis

Background: This study is conducted to investigate the effectiveness of extracorporeal shockwave lithotripsy (ESWL) after biliary stent placement compared to biliary stent placement alone in difficult common bile duct stones.Method: This is a retrospective cohort study using medical record data from the Gastrointestinal Endoscopy Center Registry of Dr. Cipto Mangunkusumo General National Hospital. We retrospectively evaluated 126 subjects with difficult bile stones. The subjects were divided into two groups: subjects subjected to biliary stent placement only and subjects who underwent ESWL procedure after the biliary stent placement. The effectiveness of the procedures was measured in the form of total clearance of bile stones.Results: A total of 126 subjects were included in this study, including 72 subjects who underwent ESWL procedure after biliary stent placement and 54 subjects who underwent biliary stent placement only. The effectiveness of ESWL after biliary stent placement in achieving total clearance was 69.1%, and the effectiveness of biliary stent placement in achieving total clearance was 64.8%. The ESWL procedure as adjuvant therapy after biliary stent placement did not provide a statistically significant difference (p = 0.703; 95% CI: 0.816–1.351). Normal body mass index was a factor that influences the effectiveness of ESWL after biliary stent placement (p = 0.002).Conclusion: The ESWL procedure as adjuvant therapy after biliary stent placement has the same level of effectiveness as biliary stent placement alone.