Gastrointestinal injury secondary to extracorporeal shock wave lithotripsy: a review of the literature since its inception

Since its inception into the United States in 1984 the popularity of extracorporeal shock wave lithotripsy (ESWL) has grown tremendously, with over 200,000 procedures performed annually. Multiple studies have proclaimed its safety and efficacy as a minimally invasive technique for the treatment of ureteral and renal lithiasis. Although gastrointestinal damage has been reported as a rare potential complication of ESWL the actual incidence is unknown. One of two studies specifically recording the incidence of GI damage by preand post-ESWL endoscopy reported gastric and duodenal erosions in 80% of the patients. There are now nine reported cases of patients with free perforation of the gastrointestinal tract and two additional cases of a ureterocolic fistula and a gastrojejunal dehiscence secondary to ESWL. The goal of treatments considered to be successful has led to higher-intensity shock waves and an increase in the number of shocks administered. The clinical significance of gastrointestinal tract injury after ESWL has become apparent as the upper limits of FDA recommendations for the number of shocks delivered and the amount of energy used are approached and even exceeded.