Abstract
In a patient with a common bile duct stone 28 mm in diameter, the traction wires of
two basket catheters fractured during endoscopic mechanical lithotripsy. Disintegration
of the concrement and removal of the impacted baskets failed even after extracorporeal
application of 8000 shockwaves. Pulsed dye laser lithotripsy was carried out via a
250 µm fiber which was advanced to the stone through a 6 French ERCP guiding catheter.
Lithotripsy could be safely performed under fluoroscopic control since the laser used
provides an automatic cut-out system upon tissue contact. 3600 of 11800 applied pulses
were emitted with the total power setting and complete disintegration of the calculus
was achieved. The baskets and the fragments could be removed endoscopically in the
same session. Laser lithotripsy with a stone recognition system would seem to improve
the applicability and safety of intracorporeal lithotripsy even when performed without
direct visual guidance.
