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Mechanical lithotripsy is the most commonly used technique to extract bile duct stones when standard techniques fail. Mechanical lithotripsy can be performed with the endoscope in place, or after the endoscope has been removed (Soehendra lithotripter). The overall success rate for bile duct clearance with mechanical lithotripsy is 80–90% although 20–30% of patients require more than one session.
Lithotripsy technique without withdrawal of the endoscope
The lithotripter consists of a metal sheath covering a polyethylene catheter which contains the basket. The end of the catheter is attached to a lithotripter handle. The basket should be connected to the handle and tested to ensure that it is working prior to inserting it. The catheter is quite rigid and can be difficult to introduce and manipulate. In these cases, a wire-guided lithotripsy basket can be used.