Mechanical lithotripsy of large common bile duct stones

Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study

“…Large stones must be fragmented before they can be extracted by ML, which is the modality used most commonly, and complete bile duct clearance can be achieved in 80% to 90% of cases after ML is applied, regardless of whether EST, EPBD, or both are performed. [26][27][28][29] Also the main purpose of LBS in endotherapy for large bile duct stones is that additive endoscopic procedure steps, such as ML, are omitted to simplify the process of stone extraction and reduce the complications. Therefore, when researchers evaluate the efficacy of LBS as a treatment option for large bile duct stones, the precise definition of success for complete clearance of bile ducts should be complete retrieval of stones by using LBS alone without adding another step or procedure.…”

Intraductal therapies

“…Up to 5-10% of bile duct stones cannot be removed by conventional methods including ERCP and mechanical lithotripsy [47,48]. Impacted stones, very large stones (≥25 mm), and stones above biliary strictures are less likely to be successfully removed by conventional methods.…”

SpyGlass®: Single Operator Choledochoscopy

“…Die Erfolgsquote einer extrakorporalen Stoßwellenlithotripsie (ESWL) mit anschließend endoskopischer Extraktion ist in diesen besonderen Fällen leider ebenfalls sehr niedrig [33][34][35]. Durch den Einsatz des SpyGlass ® -Systems mit der Möglichkeit neben der Spülung auch auf einen vollwertigen Arbeitskanal zurückzugreifen, gelingt es unter direkter Sicht eine Sonde bis an den Stein zu führen, und dann diesen direkt mittels kurzgepulsten Laserwellen (Nd-YAG-2-Laser oder Holmiumlaser) oder elektrohydraulischen Wellen zu zerkleinern [36][37][38]. Die direkte Platzierung der Sonde am Stein vermindert das Risiko einer Blutung oder Perforation im Gallengang und erhöht die Erfolgsquote der Steinextraktion gegenüber der extrakorporalen Stoßwellenlithotripsie deutlich [39,40].…”