title: Direct cholangioscopy-based holmium laser lithotripsy of difficult bile duct stones by using an ultrathin upper endoscope without a separate biliary irrigating catheter.
abstract: OBJECTIVE
  We investigated the impact of direct peroral cholangioscopy (POC)-based holmium laser lithotripsy using an ultrathin endoscope with direct irrigation via a 2-mm-diameter working channel to remove difficult common bile duct (CBD) stones without a separate biliary catheter.
  
  
  BACKGROUND
  Few clinical studies have reported the successful removal of difficult CBD stones by direct POC-based laser lithotripsy using an ultrathin upper endoscope. Previous studies used a separate biliary catheter to ensure continuous irrigation.
  
  
  METHODS
  Ten patients (6 males; mean age 63.3 years) with difficult CBD stones who were not amenable to conventional endoscopic procedures were examined. Direct POC using an ultrathin upper endoscope was performed in all patients. Holmium laser lithotripsy with direct saline irrigation via the operating channel of an ultrathin endoscope was performed until stone fragments were captured in a basket.
  
  
  RESULTS
  The overall success rate of bile duct clearance was 90% (9 of 10 patients) and the mean number of treatment sessions was 1.2 (range, 1-2). Mechanical lithotripsy was performed to complete stone removal in one patient (10%) who had a distal CBD stricture. One patient experienced mild cholangitis following laser lithotripsy.
  
  
  CONCLUSIONS
  Holmium laser lithotripsy under direct POC using an ultrathin upper endoscope may be an effective and safe technique for removal of difficult CBD stones. Direct irrigation via the 2-mm-diameter working channel of the ultrathin endoscope provides sufficient fluid medium and affords good endoscopic viewing to assure stone fragmentation without any need for a separate biliary catheter.
authors: Digestive Disease Center, Konkuk University Medical Center, Konkuk University School of Medicine, Hwayangdong, Gwangjingiu, Seoul, Korea.
authors: Tae Yoon
authors: TY
authors: Lee
authors: Young Koog
authors: YK
authors: Cheon
authors: Won Hyeok
authors: WH
authors: Choe
authors: Chan Sup
authors: CS
authors: Shim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019723:Endoscopes; D016145:Endoscopy, Digestive System; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D007507:Therapeutic Irrigation / Q000295:instrumentation