Patient education: Lithotripsy of bile or pancreatic duct stones (The Basics)

What are bile and pancreatic duct stones? — These are small stones that form inside the gallbladder or pancreas and cause a blockage:

●The gallbladder is tucked under the liver (figure 1). It stores bile, a fluid that helps the body break down fat. When you eat a meal that has fat in it, your gallbladder empties the bile into a tube called the "bile duct."

●The pancreas is also involved in digestion (figure 2). It makes hormones and juices that help break down food. These juices flow into the "pancreatic duct."

The bile duct and the pancreatic duct are connected. They empty into the small intestine through a single tube. If that tube gets blocked by a stone, fluids from the gallbladder, liver, and pancreas get backed up. This can cause pain.

When a stone is big or causes severe symptoms, it needs treatment.

What is lithotripsy? — This is a procedure to break up large or complex stones into smaller pieces.

Lithotripsy can be done in different ways. The doctor uses a special tool or shock waves from electricity or a laser to break up the stones. Then, the doctor uses an "endoscope" to help remove the stone fragments. An endoscope is a thin, flexible tube with a camera on the end.

How do I prepare for lithotripsy? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●CT or MRI – These are imaging tests that show pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during lithotripsy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will slowly guide the endoscope through your mouth and down your throat. They will push the endoscope past your stomach to the place where the stones are causing a blockage.

●Then, the doctor will use a special tool or shock waves to break up the stone into smaller pieces. They will then remove the small pieces of the stone from your bile duct.

●The doctor might also place a stent to keep your bile or pancreatic duct open. A stent is a small metal tube that holds the duct open. If a stent was put in, your doctor will tell you how long it will stay in place and how it will be removed.

●The procedure takes about an hour to complete.

What happens after lithotripsy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people are able to go home the same day, and others spend a night in the hospital after the procedure.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of lithotripsy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●Damage to the bile duct or organs

●Not being able to break up or remove stones

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Lithotripsy of bile or pancreatic duct stones – Discharge instructions (The Basics)
Patient education: Gallstones (The Basics)
Patient education: Acute pancreatitis (The Basics)
Patient education: Endoscopic retrograde cholangiopancreatography (ERCP) (The Basics)

Patient education: Gallstones (Beyond the Basics)
Patient education: Acute pancreatitis (Beyond the Basics)
Patient education: Chronic pancreatitis (Beyond the Basics)
Patient education: ERCP (endoscopic retrograde cholangiopancreatography) (Beyond the Basics)