Endoscopy 2019; 51(04): S15
DOI: 10.1055/s-0039-1681211
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: ERCP stones Club H
Georg Thieme Verlag KG Stuttgart · New York

A MULTICENTER RANDOMIZED TRIAL OF LASER VERSUS ELECTROHYDRAULIC LITHOTRIPSY FOR DIFFICULT BILE DUCT STONES

DH Koh
1   Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea, Republic of
,
J Lee
1   Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea, Republic of
,
SH Moon
2   Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea, Republic of
,
S Jung
3   Internal Medicine, Inha University College of Medicine, Incheon, Korea, Republic of
,
JH Moon
4   Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea, Republic of
,
HJ Choi
4   Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea, Republic of
,
IS Lee
5   Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea, Republic of
,
CS Shim
6   Internal Medicine, Konkuk University School of Medicine, Seoul, Korea, Republic of
,
TY Lee
6   Internal Medicine, Konkuk University School of Medicine, Seoul, Korea, Republic of
,
JK Lee
7   Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
,
JH Han
8   Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea, Republic of
,
JH Cho
9   Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea, Republic of
,
HG Kim
10   Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea, Republic of
,
SH Lee
11   Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of
,
DW Seo
12   Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
,
HJ Jang
1   Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Firstly, difficult bile duct stones were removed by mechanical lithotripsy. But, If this fail, the electrohydrulic (EHL) or laser lithotripsy (LL) could be performed. We performed the first prospective randomized controlled study to compare the efficiency and safety of LL and EHL in multicenter of South Korea.

Methods:

Between 2014 and 2016, a total of 122 patients who underwent LL or EHL was enrolled from 12 centers. All patients had failed to remove stones by conventional endoscopic stone extraction method including mechanical lithotripsy because huge stone, inaccessible major duodenal papilla, or intrahepatic bile duct (IHD) stone. For laser lithotripsy, we used holmium laser technology. Main outcome measures included complete stone clearance, procedure times and post-procedure complications.

Results:

Thirty one patients received LL and 33 received EHL. Those in the LL treatment were older, had longer procedure times (EHL33.3 ± 13.8 min, LL 47.9 ± 25.7 min, P = 0.006). There were no significant differences in stone size (EHL 15.0 ± 7.6 mm, LL 13.1 ± 4.4 mm, P = 0.235), number of session (EHL 2.4 ± 1.1, LL 3.0 ± 1.6, P = 0.113), stone location between the two treatment groups. Rate of complete clearance (EHL 90.9%, LL 96.8%, P = 0.333) and complications (EHL 15.2%, Holmium 19.4%, P = 0.656) were not different between the groups. Main complications included bleeding (n = 3), infection (n = 7), and pancreatitis (n = 1), although there were no differences in complications between the two treatments, and no severe complications were observed. Recurrence rate was 22.6% (14/62), although no differences were seen in either LL or EHL treatment groups (EHL 57.1%, Holmium 42.9%, P = 0.638). IHD stone was significantly associated with recurrence compared to common bile duct (CBD) stones (Odds ratio = 1.957, 95% confidence interval = 1.017 – 3.767, P = 0.045).

Conclusions:

Although both LL and EHL were safe and effective in the treatment of refractory CBD stones or intrahepatic stones, LL had longer procedure. However, the number of session was not different. Further large comparative studies are warranted.