THE INTERCOSTAL PATHWAY FOR BILIARY LITHOTRIPSY - AN EVALUATION

Intercostal biliary extracorporeal shock wave lithotripsy (BESWL), an alternative method for targeting retrocostal gallbladders, was evaluated in a three-stage study. First, 10 pigs (three with implanted gallstones) underwent BESWL at different, increasing shock wave pressures. Histologic studies were done in seven animals and showed no macroscopic abnormalities. Microscopically, two pigs had 1-3-mm blood collections in the shock wave path. Next, 11 patients in whom subcostal BESWL was not feasible underwent intercostal BESWL. One patient complained of contact-site tenderness after BESWL, which resolved spontaneously. Transient elevations of aspartate aminotransferase occurred in two asymptomatic patients. Finally, both pathways were evaluated in 22 consecutive patients. Intercostal BESWL was the method of choice in only two patients. In each stage of the study all intercostally targeted gallstones fragmented. It is concluded that the intercostal pathway is a valid alternative whenever subcostal BESWL proves unsatisfactory.