Pulse dye laser lithotripsy for large biliary tract stones.

From 1997 to 1998 the first series of 21 patients with large biliary tract stones (1.5-4.0 cm with average 2.5 cm in diameter) who underwent endoscopic stone extraction by using combination of ERCP and EST with automatic stone-tissue detection pulse dye laser was carried out. Male = 8, Female = 13, average age = 57.5 years (32-83) most of the stones were primary stones (71.4%). Laser fibers were controlled by balloon catheter with fluoroscope (blind technique) in 16 cases and by mother-babyscope system in 5 cases. The result in successful fragmentation of stones was 87.5 per cent with the blind technique and 100 per cent with the mother-babyscope technique. Temporary stents were used in the patients who had severe cholangitis and those who required more than one session of lithotripsy (19%). Complications consisted of controllable cholangitis in 2 cases (9.5%) and there was no mortality. We conclude that stone-tissue detection lithotripsy is very safe and effective in patients with large biliary tract stones and high surgical risk especially via the direct mother-babyscope system.