Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience (with video)

Patel, Sandeep; Rosenkranz, Laura; Hooks, Bennett; Tarnasky, Paul R.; Raijman, Isaac; Fishman, Douglas S.; Sauer, Bryan G.; Kahaleh, Michel

doi:10.1016/j.gie.2013.07.054

Cited by 68 publications

(69 citation statements)

References 19 publications

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“…In a large series that enrolled 69 patients with complex biliary stones treated with SGDS-guided HL, Patel et al [3] reported a successful extraction rate of 74% in the index ERCP. This value increased to 97% after additional sessions.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as the standard treatment for the management of biliary and pancreatic stone disease [1-3]. Extraction of bile or pancreatic duct stones can be achieved with conventional techniques such as extraction baskets, balloons, or mechanical lithotripsy, with success rates up to 95% [2-4].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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“…Endoscopic laser lithotripsy is the most recent method, but its use is still limited, also owing to the need for costly equipment (9). Recent laser lithotriptors combine the advantages of dye and solid-state lasers at a reasonably low price (10), thus potentially allowing for a future progressive diffusion of laser lithotripsy worldwide (10,11). The critical determining factors for the success of extracorporeal shock-wave lithotripsy (ESWL) are stone size/structure (12) and CBD diameter (13).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of incarcerated calculi via laparoscopic bile duct exploration using laparotomy biliary lithotomy forceps

Jiang¹,

Wang²,

Jin³

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to investigate the practicability and clinical value of applying laparotomy biliary lithotomy forceps to laparoscopic bile duct exploration (LCBDE) for the surgical treatment of incarcerated calculi. A total of 63 patients were diagnosed with cholecystolithiasis and choledocholithiasis. The present study performed a retrospective analysis of clinical samples from 16 of these patients who had incarcerated calculi at the terminus of the common bile duct, and who had been treated with laparoscopic cholecystectomy and LCBDE. During the procedure, laparotomy biliary lithotomy forceps were used to gently remove the calculi from the common bile duct. Of the surgical procedures that used laparotomy biliary lithotomy forceps, one case was unsuccessful and 15 cases were successful. The results of the present study suggested that it may be clinically advisable to use laparotomy biliary lithotomy forceps to remove incarcerated calculi from the common bile duct during a laparoscopy, since it is easy, economical and effective.

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“…The holmium:YAG laser and frequency-doubled, double-pulse neodymium:YAG (FREDDY) laser are the two commonly used lasers to crush biliary stones [49,50,52]. In holmium laser technology (Medilas H20; Dornier Medtech, Munich, Germany) the energy is delivered via a 365-µm-diameter fiber, with energy levels set at 800-1500 mJ at a frequency of 8-15 Hz.…”

Section: Laser Lithotripsymentioning

confidence: 99%

“…However, direct contact with tissue should be avoided and sufficient saline irrigation should be used to prevent adjacent thermal soft tissue effects. The distance between the laser fiber tip and stone is of paramount importance to achieve maximum stone fragmentation [52]. This distance should be 1 to 2 mm to achieve maximum stone fragmentation (Figure 9.4).…”

Section: Laser Lithotripsymentioning

confidence: 99%

Intraductal therapies

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Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience (with video)

Cited by 68 publications

References 19 publications

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Surgical treatment of incarcerated calculi via laparoscopic bile duct exploration using laparotomy biliary lithotomy forceps

Intraductal therapies

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