Clinical role of frequency-doubled double-pulsed yttrium aluminum garnet laser technology for removing difficult bile duct stones (with videos).
BACKGROUND
Very few clinical trials have reported on the success rate of frequency-doubled double-pulse yttrium aluminum garnet (YAG) laser (FREDDY) technology for removal of difficult bile duct stones.


OBJECTIVE
Our purpose was to evaluate the role of FREDDY technology for removing difficult bile duct stones.


METHODS
Nonrandomized, retrospective study.


METHODS
Academic medical center.


METHODS
Fifty-two patients with difficult bile duct stones were treated via the transpapillary route by using a FREDDY system. The inclusion criteria were impacted or large common bile duct stones (>15 mm, mean 23.5 mm, range 15-35 mm, mean number of stones 1.7, range 1-4). Laser lithotripsy was performed with cholangioscopy guidance in 7 patients and fluoroscopic guidance alone in 45 patients.


METHODS
The success rate of complete stone removal and the complication rate related to the procedure.


RESULTS
Of the 52 patients treated via the transpapillary route, complete stone removal was achieved in 48 patients (92.3%). The complete removal of stones required a mean of 1.4 (range 1-2) endoscopic sessions. The rate of complications related to laser lithotripsy was 23.0% (acute pancreatitis, 3 cases; transient hemobilia, 8 cases; acute cholangitis, 1 case).


CONCLUSIONS
Nonrandomized, retrospective design.


CONCLUSIONS
Laser lithotripsy by using the FREDDY system seems safe and effective and allows "blind" fragmentation of bile duct stones under fluoroscopic guidance only.
Cho
Young Deok
YD
Department of Internal Medicine, Institute for Digestive Research, Soon Chun Hyang University, College of Medicine, Seoul, Korea. ydcho@hosp.sch.ac.kr
Cheon
Young Koog
YK
Moon
Jong Ho
JH
Jeong
Soung Won
SW
Jang
Jae Young
JY
Lee
Joon Seong
JS
Shim
Chan Sup
CS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies