Safety and efficacy of laser lithotripsy for complicated biliary stones using direct choledochoscopy

Bryan G. Sauer, Mark Cerefice, Douglas C. Swartz, Monica Gaidhane, Animesh Jain, Shahzad Haider, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)253-256
Number of pages4
JournalDigestive diseases and sciences
Volume58
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Keywords

  • Choledocholithiasis
  • Choledochoscopy
  • Complicated biliary stones
  • ESWL
  • Extracorporeal shockwave lithotripsy
  • Laser lithotripsy

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