Abstract
Background/study aims Laser lithotripsy can effectively fragment
complicated biliary stones, but current cholangioscopes are limited by
fragility, restricted mobility or moderate visual resolution. The efficacy and
safety of a new digital single-operator peroral cholangioscope to guide laser
lithotripsy were evaluated.
Patients and methods In this prospective single-center series, consecutive
patients with complicated biliary stones, defined as impacted stones > 1.5 cm
in size and wider than the more distal common bile duct, or stones that failed
extraction by basket mechanical lithotripsy, underwent ERCP and SpyGlass DS
peroral cholangioscope (Boston Scientific, Marlborough, United States)-guided
laser lithotripsy. Stone clearance rate and incidence of adverse events were
determined.
Results Seventeen patients (10 men, 7 women; median age 76 years) with a
median biliary stone size of 2 cm underwent predominantly holmium:yttrium
aluminum garnet laser lithotripsy, achieving a 94 % stone clearance rate over 1
median procedure. Lithotripsy was performed in 8 of 17 patients due to an
impacted biliary stone. The remaining patients underwent lithotripsy due to
prior failure of the basket mechanical lithotripter to capture or crush their
stones. Post lithotripsy, 2 patients developed cholangitis and 1 patient with
underlying COPD developed respiratory distress, all resolved with conservative
management. There were no hemobilia, perforations, pancreatitis nor any deaths.
Conclusion SpyGlass DS peroral cholangioscopy-guided laser lithotripsy is
an efficient and safe modality for management of complicated biliary
stones.
