Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system

Abstract

Introduction-Laser lithotripsy of bile duct stones has become a widely accepted endoscopic treatment modality for giant, impacted, or very hard stones. The procedure is usually carried out under direct endoscopic control in view of the potential risk of bile duct injuries in "blind" laser application. Aims-To investigate the use of a rhodamine 6G laser lithotriptor with an integrated optical stone tissue detection system (oSTDS). Methods-From 1 September 1991 to 7March 1997, 60 patients with giant or impacted common bile duct stones refractory to endoscopic papillotomy stone extraction, and mechanical lithotripsy were treated via the endoscopic retrograde route using a rhodamine 6G dye laser (595 nm, 2.5 µs, 80-150 mJ pp, Lithognost Telemit/Baasel Corp., Germany) with integrated oSTDS. In case of tissue contact oSTDS cuts oV the laser pulse after 190 ns (transmission of 5-8% of the total pulse energy). 47 patients (78.3%) were subjected to x ray targeting (oSTDS) alone, five (8.3%) to choledochoscope targeting alone, and eight (13.3%) to both techniques. Results-At the end of treatment 52 (87%) patients were completely stone-free. The only major complications included transient haemobilia, cholangitis, and pancreatitis in five patients. All five were successfully treated by conservative methods. Conclusions-Laser lithotripsy using the described rhodamine 6G dye laser with oSTDS seems to be safe and eVective and allows "blind" fragmentation of diYcult common bile duct stones under radiological control only. (Gut 1998;43:823-829)

Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians

“…This success rate is within the range of previously reported rates (74-90%) [9,10]. If EHL or ILL had not been used, permanent stent placement probably would have been the only other treatment option for these patients.…”

“…The second line of treatment, fragmentation of the stone by mechanical lithotripsy, has a convincing success rate of 80% to 90% [3][4][5][6][7]. The third-line methods of lithotripsy include intraductal electrohydraulic lithotripsy (EHL) and intraductal laser lithotripsy (ILL), both of which are aided by peroral cholangioscopy using a mother-baby-scope system [8][9][10]. External shock-wave lithotripsy (ESWL) is another third-line option [11][12][13].…”

Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

“…Cholangioscopy was used to guide LISL therapy in 1� of the 18 cases (14) . Another series of 60 patients also demonstrated that when LISL is performed by means of transpapillary cholangioscopy, there is a need for a lesser number of laser impulses than when it is performed "blindly" (1,540 vs 2,017 impulses, P <0.05) (8) . However, it must be emphasized that a lesser number of laser impulses does not mean greater safety to the patient, nor a higher procedure efficacy, since the meeting rate with both forms of laser steering is similar as well as the stone free end result.…”

Endoskopie in der Gastroenterologie und in der Viszeralchirurgie: Selbständige Abteilungen für Endoskopie? – Für und Wider

“…[7], Halle [8] Bonn [9] München [10] Gallenwegskarzinom Photodynamische Therapie Berlin [11], Leipzig [12] Cholecystolithiasis ESWL Erlangen [13], München [14] Choledocholithiasis EPT, Lithotripsie Erlangen [15,16], München [17] Pankreaskarzinom MRCP vs. ERCP Berlin [18], Ludwigshafen [19] Akute Pankreatitis Papillotomie Kiel [20] Kolonadenom/Kolonkarzinom Polypektomie Erlangen [21] …”