Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1308-1314, December 2011

Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos)

  • Amit Maydeo, MD

      Affiliations

    • Institute of Advanced Endoscopy, Mumbai, India
    • Corresponding Author InformationReprint requests: Dr Amit Maydeo, 5th Floor, Om Chambers, 123 August Kranti Marg, Mumbai 400036 India
    • ,
  • Boon Eu Andrew Kwek, MRCP

      Affiliations

    • Changi General Hospital, Singapore
    • ,
  • Suryaprakash Bhandari, MD

      Affiliations

    • Institute of Advanced Endoscopy, Mumbai, India
    • ,
  • Mukta Bapat, MD

      Affiliations

    • Institute of Advanced Endoscopy, Mumbai, India
    • ,
  • Vinay Dhir, MD

      Affiliations

    • Institute of Advanced Endoscopy, Mumbai, India

Received 8 June 2011; accepted 23 August 2011.

Background

Scant data exist on the utility of the holmium:yttrium-aluminum-garnet laser for the treatment of biliary or pancreatic duct stones.

Objective

To evaluate the efficacy and safety of fiberoptic probe and catheter system-guided holmium laser lithotripsy of difficult biliary and pancreatic duct stones.

Design

Prospective study.

Setting

Tertiary-care referral center.

Patients

This study involved 64 patients who underwent holmium laser stone fragmentation.

Intervention

A total of 64 patients (60 bile duct stones, 4 pancreatic duct stones) underwent endoscopic retrograde stone fragmentation with a holmium laser and a fiberoptic probe and catheter system. The inclusion criterion for bile duct stones was stones not amenable to retrieval by mechanical lithotripsy and/or balloon sphincteroplasty or standard techniques. Pancreatic duct stones included in this study were not amenable to removal by stone retrieval basket or balloon.

Main Outcome Measurements

Rates of ductal clearance and procedural complications.

Results

All 64 patients had successful fragmentation of biliary and pancreatic duct stones with the holmium laser. Fifty of 60 patients (83.3%) had complete biliary duct clearance after a single session; 10 patients required an additional session. All pancreatic duct stones were fragmented in a single session. Mean duration of ERCP sessions was 45.9 minutes (range 30-90 minutes). Complications were mild and were encountered in 13.5% of patients; fever (n = 3), transient abdominal pain (n = 4), and biliary stricture (n = 1).

Limitations

No comparative treatment group.

Conclusion

The fiberoptic probe and catheter system facilitates transpapillary access for holmium laser fragmentation of difficult biliary and pancreatic duct stones. The technique is safe and highly effective for single-setting duct clearance. Complications are minimal and transient.

Abbreviations:  EHL, electrohydraulic lithotripsy , ESWL, extracorporeal shockwave lithotripsy , FREDDY, frequency-doubled, double-pulse neodymium:YAG laser , Nd:YAG, neodymium:yttrium-aluminum-garnet , YAG, yttrium-aluminum-garnet

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 DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

 If you would like to chat with an author of this article, you may contact Dr Maydeo at ddc_endo@hotmail.com.

PII: S0016-5107(11)02164-X

doi:10.1016/j.gie.2011.08.047

Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1308-1314, December 2011

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