title: Complex biliary stones: treatment with a small choledochoscope and laser lithotripsy.
abstract: OBJECTIVE
  To evaluate the use of a small choledochoscope and laser lithotripsy in the treatment of complex biliary stone disease.
  
  
  METHODS
  Twenty-five consecutive patients with complex biliary stone disease not amenable to surgical therapy, peroral endoscopic removal, or simple percutaneous retrieval techniques underwent 35 stone-removal procedures. A 3.4-mm endoscope and a pulsed dye coumarin green laser were used to pulverize and remove stones through preexisting, mature transhepatic biliary drain tracts (n = 18), t-tube tracts (n = 3), cholecystostomy tube tracts (n = 3), and a hepaticocutaneous enterostomy (n = 1). Procedures in 14 of the 25 patients (56%) were performed on an outpatient basis.
  
  
  RESULTS
  Twenty-four of the 25 patients (96%) were cleared of their stone burden and underwent subsequent catheter therapy of strictures or abscesses as necessary. Complications of the stone removal included fever and chills in six patients (24%) and mild bleeding from a bile duct wall during removal of an adherent stone in one patient.
  
  
  CONCLUSIONS
  Use of a small choledochoscope and a coumarin green pulsed dye laser is safe and effective in the management of complex biliary stone disease.
authors.affiliation: Department of Radiology, Indiana University Medical Center, University Hospital, Indianapolis 46202-5253, USA.
authors.forename: V J
authors.initials: VJ
authors.lastname: Harris
authors.forename: S
authors.initials: S
authors.lastname: Sherman
authors.forename: S O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: J J
authors.initials: JJ
authors.lastname: Snidow
authors.forename: M S
authors.initials: MS
authors.lastname: Johnson
authors.forename: G A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002767:Cholecystostomy; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage / Q000379:methods; D016145:Endoscopy, Digestive System / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013997:Time Factors