title: [Endoscopic laser lithotripsy for difficult calculi after unsuccessful extracorporeal shock wave lithotripsy].
abstract: BACKGROUND
  More than 97% of common bile duct stones can be successfully managed by endoscopic papillotomy, mechanical lithotripsy and extracorporeal shock-wave lithotripsy. In this study, we evaluate the role of laser lithotripsy after failure of the above mentioned endoscopic methods.
  
  
  METHODS
  Eighteen patients (15F, 3M; median age = 69 (28-83) years) were treated by endoscopic laser lithotripsy after ESWL failure. We employed a Rhodamine-6 G laser with a stone-tissue recognizing system. The laser fibers were cholangioscopically (direct vision) or blindly (under plain fluoroscopic control) placed.
  
  
  RESULTS
  Seventeen patients were treated endoscopically and one was successfully managed percutaneously after failure of the transpapillary approach. Fourteen (78%) were stone-free after a mean of 1.56 laser therapy sessions alone. Two additional patients were successfully managed after partial fragmentation with combined treatment (mechanical lithotripsy: n = 1, electrohydraulic lithotripsy: n = 1). Overall, 89% of the patients were freed from their calculi. Cholangitis occurred once and the mortality was zero.
  
  
  CONCLUSIONS
  We conclude that laser lithotripsy is an effective and safe treatment alternative in a highly selected patient population with difficult bile duct stones and considerable surgical risk.
authors.affiliation: Hospital de Clínicas de Ludwigshafen, Alemanha.
authors.forename: R
authors.initials: R
authors.lastname: Jakobs
authors.forename: J C
authors.initials: JC
authors.lastname: Pereira-Lima
authors.forename: M
authors.initials: M
authors.lastname: Maier
authors.forename: B
authors.initials: B
authors.lastname: Kohler
authors.forename: C
authors.initials: C
authors.lastname: Benz
authors.forename: H E
authors.initials: HE
authors.lastname: Adamek
authors.forename: J F
authors.initials: JF
authors.lastname: Riemann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure