BACKGROUND: The first-line therapy for choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction, which is successful in over 90% of cases. However, large biliary stones often require extracorporeal shockwave lithotripsy, electrohydraulic lithotripsy (EHL), or laser lithotripsy. The objective of our study was to assess the safety and efficacy of laser lithotripsy with choledochoscopy guidance. METHODS: Between March 2001 and November 2009, laser lithotripsy with a holmium laser was used for complicated bile stones in 20 patients. All patients included had failed standard stone extraction techniques after a mean of 2.1 ± 1.1 ERCP sessions. Main outcome measures included complete stone clearance and complications post-procedure. RESULTS: Twenty patients (mean age 61.0 ± 22.3 years, six men) underwent laser lithotripsy with a mean stone size was 2.2 cm (range 1.1-3.5 cm) and a mean number of stones of 2.2 (range 1-6). A mean of 0.25 ± 0.20 kJ was applied during laser lithotripsy sessions with a mean procedure time of 85.3 ± 23.0 min. The majority (18/20, 90%) achieved final clearance after a mean of 1.4 ± 0.8 (29 total) laser sessions and a mean of 1.9 ± 0.8 (38 total) ERCP sessions. Five complications occurred: two patients required post-procedure admission for pain and three patients had bile leaks. All bile leaks were minor and resolved after biliary stenting. CONCLUSIONS: Laser lithotripsy using the holmium laser is safe and effective with direct cholangioscopic guidance. Further prospective studies are warranted.
BACKGROUND: The first-line therapy for choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction, which is successful in over 90% of cases. However, large biliary stones often require extracorporeal shockwave lithotripsy, electrohydraulic lithotripsy (EHL), or laser lithotripsy. The objective of our study was to assess the safety and efficacy of laser lithotripsy with choledochoscopy guidance. METHODS: Between March 2001 and November 2009, laser lithotripsy with a holmium laser was used for complicated bile stones in 20 patients. All patients included had failed standard stone extraction techniques after a mean of 2.1 ± 1.1 ERCP sessions. Main outcome measures included complete stone clearance and complications post-procedure. RESULTS: Twenty patients (mean age 61.0 ± 22.3 years, six men) underwent laser lithotripsy with a mean stone size was 2.2 cm (range 1.1-3.5 cm) and a mean number of stones of 2.2 (range 1-6). A mean of 0.25 ± 0.20 kJ was applied during laser lithotripsy sessions with a mean procedure time of 85.3 ± 23.0 min. The majority (18/20, 90%) achieved final clearance after a mean of 1.4 ± 0.8 (29 total) laser sessions and a mean of 1.9 ± 0.8 (38 total) ERCP sessions. Five complications occurred: two patients required post-procedure admission for pain and three patients had bile leaks. All bile leaks were minor and resolved after biliary stenting. CONCLUSIONS: Laser lithotripsy using the holmium laser is safe and effective with direct cholangioscopic guidance. Further prospective studies are warranted.
Authors: S Amplatz; L Piazzi; M Felder; M Comberlato; S Benvenuti; L Zancanella; F Di Fede; A de'Guelmi; A Bertozzo; P Farris; T Grasso; A Mega; F Chilovi Journal: Dig Liver Dis Date: 2007-02-01 Impact factor: 4.088
Authors: J J Bergman; E A Rauws; P Fockens; A M van Berkel; P M Bossuyt; J G Tijssen; G N Tytgat; K Huibregtse Journal: Lancet Date: 1997-04-19 Impact factor: 79.321
Authors: Jong Ho Moon; Bong Min Ko; Hyun Jong Choi; Su Jin Hong; Young Koog Cheon; Young Deok Cho; Joon Seong Lee; Moon Sung Lee; Chan Sup Shim Journal: Gastrointest Endosc Date: 2009-04-25 Impact factor: 9.427
Authors: Antonio Navarro-Sánchez; Hutan Ashrafian; Juan José Segura-Sampedro; Alberto Martrinez-Isla Journal: Surg Endosc Date: 2016-08-29 Impact factor: 4.584
Authors: Facundo Galetti; Diogo Turiani Hourneaux de Moura; Igor Braga Ribeiro; Mateus Pereira Funari; Martin Coronel; Amit H Sachde; Vitor Ottoboni Brunaldi; Tomazo Prince Franzini; Wanderley Marques Bernardo; Eduardo Guimarães Hourneaux de Moura Journal: Arq Bras Cir Dig Date: 2020-06-26