Clinical role of frequency-doubled double-pulsed yttrium aluminum garnet laser technology for removing difficult bile duct stones (with videos)

Background

Very few clinical trials have reported on the success rate of frequency-doubled double-pulse yttrium aluminum garnet (YAG) laser (FREDDY) technology for removal of difficult bile duct stones.

Objective

Our purpose was to evaluate the role of FREDDY technology for removing difficult bile duct stones.

Design

Nonrandomized, retrospective study.

Setting

Academic medical center.

Patients

Fifty-two patients with difficult bile duct stones were treated via the transpapillary route by using a FREDDY system. The inclusion criteria were impacted or large common bile duct stones (>15 mm, mean 23.5 mm, range 15-35 mm, mean number of stones 1.7, range 1-4). Laser lithotripsy was performed with cholangioscopy guidance in 7 patients and fluoroscopic guidance alone in 45 patients.

Main Outcome Measurements

The success rate of complete stone removal and the complication rate related to the procedure.

Results

Of the 52 patients treated via the transpapillary route, complete stone removal was achieved in 48 patients (92.3%). The complete removal of stones required a mean of 1.4 (range 1-2) endoscopic sessions. The rate of complications related to laser lithotripsy was 23.0% (acute pancreatitis, 3 cases; transient hemobilia, 8 cases; acute cholangitis, 1 case).

Limitations

Nonrandomized, retrospective design.

Conclusion

Laser lithotripsy by using the FREDDY system seems safe and effective and allows “blind” fragmentation of bile duct stones under fluoroscopic guidance only.

Abbreviations: CBD, common bile duct, FREDDY, frequency-doubled double-pulse neodymium YAG laser, EHL, electrohydraulic lithotripsy, YAG, yttrium aluminum garnet