Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos) - 02/12/11
Reprint requests: Dr Amit Maydeo, 5th Floor, Om Chambers, 123 August Kranti Marg, Mumbai 400036 IndiaRésumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : EHL, ESWL, FREDDY, Nd:YAG, YAG
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Maydeo at ddc_endo@hotmail.com. |
Vol 74 - N° 6
P. 1308-1314 - décembre 2011 Retour au numéro
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