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Minimal invasive methods compete with surgical treatment in the therapy of complications after cholecystectomy. In this retrospective study we evaluate the efficacy of endoscopically placed biliary stents in 35 patients (25 female, ten male) with biliary strictures and/or leakage after cholecystectomy. 27 patients received a 10- or 11.5-French endoprosthesis, eight patients needed a percutaneous-transhepatic-cholangio-drainage (PTCD). Four patients (11.4%) underwent a surgical therapy. Endoscopic therapy was successfully completed in 23 patients (65.7%), at which we noticed a superior result in patients with early incidenced stenosis/leakages after cholecstectomy. During a follow-up period of 1-109 months (median 28 months) two recurrent strictures (5.7%) were observed. As a complication we have seen a prosthesis-dislocation after PTCD. None of the patients died of complications related to endoscopic therapy.

We report on a 70 year old patient with a great relapse in the region of the anastomosis after a palliative, subtotal gastrectomy with Billroth-II-gastrojejunostomie because of an adenocarcinoma one year before. He was unable to swallow fluids or solid food. The possibility of a sufficient gastroenteroanastomosis was certainly limited (great tumor-mass left during operation). So we implantated two metal stents in the afferent and the efferent limb, respectively. The patient's vomiting completely relieved and he was able to swallow fluid food again. After that treatment the patient's quality of live noticeably increased. Furthermore, by stenting the afferent limb a sufficient drainage out of the duodenum could be reached, thereby preventing an increasing cholestasis.

Aim: Extracorporeal shock-wave lithotripsy (ESWL) with underwater spark discharge and stone localisation via x-ray has become established in the treatment of difficult bile duct stones. First results with the piezoelectric lithotripter (EPL) in our department have also been promising., Method: Between 1989 and 1993 we were able to treat 79 patients (mean age 76 years) with problematic bile duct stones with the EPL. Twenty-seven patients had solitary stones, 52 patients presented with multiple stones. Seventy-one patients received a nasobiliary tube to decompress the biliary system. For extracorporeal lithotripsy, we used a piezoelectric lithotripter (Piezolith 2300, R. Wolf, Knittlingen, Germany)., Results: Visualisation of the stones by ultrasound and ensuing treatment were possible in 71 out of 79 patients (90%), and complete stone removal was achieved in 62 patients (78.5%) after 7,595 shock-waves were applied per patient on average. In 55 patients, endoscopic extraction of fragments was performed to avoid fragment complications. Nearly all patients in whom extracorporeal lithotripsy failed were cleared of their stones by additional use of intracorporeal electrohydraulic lithotripsy. Three patients received palliatively an endoprosthesis and two patients were referred to surgery., Conclusion: EPL with sonographic stone localisation and mild sedo-analgesia is a valuable adjunct in the treatment of difficult biliary tract calculi. It is a worthwhile alternative especially for elderly patients who would be at high risk on general anaesthesia.