Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones.
Background/study aimsLaser lithotripsy can effectively fragment complicated biliary stones, but current cholangioscopes are limited by fragility, restricted mobility or moderate visual resolution. The efficacy and safety of a new digital single-operator peroral cholangioscope to guide laser lithotripsy were evaluated.Patients and methodsIn this prospective single-center series, consecutive patients with complicated biliary stones, defined as impacted stones > 1.5 cm in size and wider than the more distal common bile duct, or stones that failed extraction by basket mechanical lithotripsy, underwent ERCP and SpyGlass DS peroral cholangioscope (Boston Scientific, Marlborough, United States)-guided laser lithotripsy. Stone clearance rate and incidence of adverse events were determined.ResultsSeventeen patients (10 men, 7 women; median age 76 years) with a median biliary stone size of 2 cm underwent predominantly holmium:yttrium aluminum garnet laser lithotripsy, achieving a 94 % stone clearance rate over 1 median procedure. Lithotripsy was performed in 8 of 17 patients due to an impacted biliary stone. The remaining patients underwent lithotripsy due to prior failure of the basket mechanical lithotripter to capture or crush their stones. Post lithotripsy, 2 patients developed cholangitis and 1 patient with underlying COPD developed respiratory distress, all resolved with conservative management. There were no hemobilia, perforations, pancreatitis nor any deaths.ConclusionSpyGlass DS peroral cholangioscopy-guided laser lithotripsy is an efficient and safe modality for management of complicated biliary stones.
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
John Ct
JC
Wong
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
Raymond Sy
RS
Tang
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
Anthony Yb
AY
Teoh
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
Joseph Jy
JJ
Sung
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
James Yw
JY
Lau