title: Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones (with video).
abstract: BACKGROUND
  Direct peroral cholangioscopy (POC) by using an ultra-slim endoscope provides direct visualization of the bile duct and allows for therapeutic intervention. Holmium laser lithotripsy can be effective for retained bile duct stones, but it requires direct visualization during the procedure for safe and effective fragmentation. Direct POC by using an ultra-slim endoscope may facilitate holmium laser lithotripsy.
  
  
  OBJECTIVE
  To evaluate the feasibility, success rates, and complications of holmium laser lithotripsy under direct POC by using an ultra-slim endoscope for retained bile duct stones.
  
  
  METHODS
  Observational clinical feasibility study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  This study involved 13 patients with retained bile duct stones whose treatment failed by a conventional lithotripsy method involving mechanical lithotripsy.
  
  
  METHODS
  Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope.
  
  
  METHODS
  Success rate of complete stone removal and procedure-related complications.
  
  
  RESULTS
  Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope was successful in 11 of 13 patients (84.6%). Although direct POC was successful, holmium laser lithotripsy failed in 2 patients because of inaccurate targeting of the laser fiber to stones. There were no procedure-related complications except one case of mild pancreatitis.
  
  
  CONCLUSIONS
  A small number of patients and no comparison with other lithotripsy systems.
  
  
  CONCLUSIONS
  Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope was feasible and can be a safe endoscopic management method for retained bile duct stones.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Hoon Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jong Chan
authors.initials: JC
authors.lastname: Lee
authors.forename: Hyung Su
authors.initials: HS
authors.lastname: Ahn
authors.forename: A Ri
authors.initials: AR
authors.lastname: Song
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome