Laser lithotripsy of difficult biliary stones.
From June 1991 to September 1992, 16 patients (mean age, 72 +/- 5 years) were treated with intra-corporeal laser lithotripsy (ICL). Thirteen patients had choledocholithiasis with at least one stone larger than 20 mm; 3 patients had intra-hepatic lithiasis. All other methods, including mechanical lithotripsy, extra-corporeal lithotripsy (1 case), and intra-corporeal electrohydraulic lithotripsy (1 case), had failed to clear the bile ducts. Approaches for ICL were choledochoscopy with a "baby" endoscope via an existing sphincterotomy (8 cases), retrograde cholangioscopy with a gastroscope through a choledochoduodenal anastomosis or a sphincterotomy in patients with a gastrojejunal anastomosis (5 cases), and trans-hepatic cholangioscopy with a fibercholangioscope (3 cases, in 1 of which retrograde and trans-hepatic approaches were combined). Free bile ducts were obtained in 14/16 (87.5%) patients after a mean of 1.66 ICL sessions per patient. Mortality and laser-related morbidity did not occur; endoscopy-related morbidity was 12.5% for minor complications (1 transitory fever, 1 mild and transitory hemobilia) and 6.25% for major complications (1 post-sphincterotomy hemorrhage). Mean length of hospital stay was 11.5 +/- 2.5 days. We conclude that although it is rarely indicated and is expensive, ICL does offer a limited treatment option in selected patients. It allows the complete relief of complex biliary lithiasis. Morbidity is related to maneuvers preceding ICL, not to ICL itself.
Prat
F
F
Service des Maladies du Foie et de l'Appareil Digestif, Hopital de Bicêtre, Le Kremlin-Bicêtre, France.
Fritsch
J
J
Choury
A D
AD
Frouge
C
C
Marteau
V
V
Etienne
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy; D002769:Cholelithiasis / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006431:Hemobilia / Q000209:etiology; D006801:Humans; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome