Background and Aims: Lithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL). Methods: In this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations. Results: Although many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs. Conclusions: Several lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones.
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The following authors disclosed financial relationships relevant to this publication: R. Watson: Consultant for Boston Scientific. M. Parsi: Consultant for Boston Scientific. H. Aslanian: Consultant for Olympus and Boston Scientific. A. Goodman: Consultant for Invendo Medical. D. Lichtenstein: Consultant for Olympus Corporation of the Americas. U. Navaneethan: Consultant for AbbVie, Janssen, and Takeda. R. Pannala: Consultant for Boston Scientific Corporation; research funding from Fujifilm USA. A. Sethi: Consultant for Boston Scientific Corporation and Olympus. S. Sullivan: Consultant for Aspire Bariatrics, Obalon, Elira, USGI Medical, and GI Dynamics; contracted research with Aspire Bariatrics, Allurion, Obalon, Elira, BARONova, USGI Medical, and GI Dynamics; stock warrants with Elira. N. Thosani: Consultant for Boston Scientific, Medtronic, and Mederi; speaker for Boston Scientific, Medtronic, and AbbVie. G. Trikudanathan: Advisory Board for AbbVie (Oct 2017). All other authors disclosed no financial relationships relevant to this publication.