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  • Title: Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos).
    Author: Maydeo A, Kwek BE, Bhandari S, Bapat M, Dhir V.
    Journal: Gastrointest Endosc; 2011 Dec; 74(6):1308-14. PubMed ID: 22136776.
    Abstract:
    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.
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