Parasites and Biliary stones

Treatment of calcular obstructive jaundice ٨٣
of pigtail over straight stents for definitive treatment of CBDS is however
limited (Hui et al., 2003).
Extracorporeal shockwave lithotripsy:
Extracorporeal shockwave lithotripsy (ESWL) was first used
treating gallstones in 1980s following its successful use in fragmenting
renal calculi (Sauerbruch et al., 1986). Shock waves are generated
outside the body using electrohydraulic, electromagnetic shockwave
systems. First generation lithotriptors required patients to be immersed in
a water bath and often required general anaesthesia. Subsequent
generation of lithotriptors do not require immersion in a water bath and
can be performed under intravenous sedation. Complete duct clearance of
common bile duct stones following ESWL range between 83% and 93%.
The majority of patients will require endoscopic extraction of the bile
stone fragments following ESWL, although approximately 10% of stones
may subsequently pass spontaneously following treatment (Sackmann et
al., 2001).
Chemical dissolution therapy:
Due to the side effects of the chemical used (diethyl ether), the
procedure was not widely practiced. The discovery of mono-octanoin as a
cholesterol stone dissolving agent, not also effective to remove CBDS
(Palmer and Hofmann, 1986). The chemical is administered via a
nasobiliary catheter, T-tube or percutaneous catheter and therapy is
required for at least several weeks making therapy less practical. The use
of methyl tertiary butyl ether (MTBE) has advantages over other
chemical dissolution agents, mainly that of faster kinetics (Neoptolemos
et al., 1990).