title: Percutaneous transhepatic endoscopic holmium laser lithotripsy for intrahepatic and choledochal biliary stones.
abstract: OBJECTIVE
  To report our experience in treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL).
  
  
  METHODS
  Ten symptomatic patients with intrahepatic or common bile duct calculi underwent PTBL. Six of these patients had previously undergone unsuccessful endoscopic treatment; four patients were declared not suitable for endoscopic procedure. PTBL was performed with a flexible choledochoscopy inserted by way of the percutaneous access sheath. A holmium laser was used to fragment the biliary stones. Sphincteroplasty was performed when considered necessary and an occlusion balloon for the clearance of common bile duct (CBD) calculi was used when continuous warm saline irrigation at high pressure was not sufficient. Clinical follow up was performed by the referring physician. Technical success, clinical success and complications were evaluated.
  
  
  RESULTS
  Technical success rate was 100%. The overall clinical success rate was 100%. No patients underwent additional procedures for retained stones or developed de novo strictures or other complications related to the procedure. Hospital stay was no more than 4 days after the procedure. Duration of follow-up was 6-25 months (mean 12.6). One patient died from unrelated causes. During this period, no recurrence and/or complications related to procedure were observed. No major complications were registered. Minor complications like temporary abdominal pain were considered not significant by the patients.
  
  
  CONCLUSIONS
  Complicated or large biliary calculi can be treated successfully using PTBL. In selected patients, this approach should become the first choice of treatment after other treatments are rejected.
authors.affiliation: Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ierardi
authors.affiliation: Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Fontana
authors.affiliation: Department of Radiology, Second University of Naples, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petrillo
authors.affiliation: Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Floridi
authors.affiliation: Second Division of Surgery, Ospedale di Circolo, Fondazione Macchi, Varese, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cocozza
authors.affiliation: Department of Gastroenterology, University of Insubria, Varese, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Segato
authors.affiliation: Radiology Department, Al Qassimi Hospital, Sharjah, UAE.
authors.forename: Hatem
authors.initials: H
authors.lastname: Abou El Abbas
authors.affiliation: Department of Surgery, University of Insubria, Varese, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mangano
authors.affiliation: Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.affiliation: Department of Surgery, University of Insubria, Varese, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D053844:Lasers, Solid-State; D007902:Length of Stay; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Biliary stones; Holmium laser lithotripsy; Percutaneous lithotripsy