Complex biliary stones: treatment with a small choledochoscope and laser lithotripsy.

Abstract

Use of a small choledochoscope and a coumarin green pulsed dye laser is safe and effective in the management of complex biliary stone disease.

Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

“…The success rate has been shown to be 95%, and complication rates have been reported to be around 4% (8-11). However, the Dormia basket method requires a larger tract diameter, and it should be reserved for at least 4-6 weeks for maturation of the transhepatic tract (8, 9, 12-15). Our technique requires only 3-4 days after PTBD, which can reduce hospitalization period.…”

Clinical applications of plasma shock wave lithotripsy in treating postoperative remnant stones impacted in the extra- and intrahepatic bile ducts

“…The complications included hemobilia, fever, and bleeding. According to the best results reported by Harris et al [6], the success rate for fragmentation of stone by laser lithotripsy was 96% (24/25), whereas the complication rate was 28% (7/25).…”

“…Laser has been used to fragment stones in common bile duct and the intrahepatic bile duct [6,12,13]. Orii et al [12] reported that yttrium-aluminum laser conferred enough power to crush pigment stones (8 cases), but that its ecacy against cholesterol stones was less than satisfactory (3 cases).…”

“…The relatively rigid, sharp ®lament may perforate the side wall of the working channel if advanced with force through a bent scope. Firing the laser while the tip of the ®lament is inside the working channel also can damage the lining of the channel [6]. Those shortcomings limit the ecacy of laser lithotripsy.…”

Use of the Angiojet Thrombectomy Device to Facilitate Removal of Impacted Intrahepatic Ductal Debris

“…This method usually entails some degree of physical disruption and maceration of the stones before their removal through a sheath. Other methods include balloon or catheter manipulation, laser lithotripsy, electrohydraulic and mechanical lithotripsy, and direct choledochoscopic removal [3]. La Berge et al [4] described the use of a percutaneous thrombectomy device (Arrow-Trerotola PTD; Arrow International, Reading, PA) to remove retained common duct stones.…”