Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study

Endoscopy
Phonthep AngsuwatcharakonRungsun Rerknimitr

Abstract

Endoscopic papillary large-balloon dilation (EPLBD) allows for the complete removal of large common bile duct (CBD) stones without fragmentation; however, a significant proportion of very large stones and stones floating above a tapering CBD require lithotripsy. Mechanical lithotripsy and cholangioscopy-guided laser lithotripsy are both effective for stone fragmentation. This study aimed to directly compare, for the first time, the efficacy of these two techniques in terms of stone clearance rate, procedure duration, patient radiation exposure, and safety. 32 patients with very large CBD stones or with stones floating above a tapering CBD, and in whom extraction after standard sphincterotomy and/or EPLBD had failed, were randomly assigned to mechanical lithotripsy or cholangioscopy-guided laser lithotripsy at two tertiary referral centers. Crossover was allowed as a rescue treatment if the assigned technique failed. Patients' demographic data were not different between the two groups. Mechanical lithotripsy had a significantly lower stone clearance rate in the first session compared with laser lithotripsy (63% vs. 100%; P < 0.01). Laser lithotripsy rescued 60% of patients with failed mechanical lithotripsy by achieving complete...Continue Reading

Citations

Jul 26, 2019·Current Treatment Options in Gastroenterology·Yusuke IshidaYoshinobu Okabe
Jul 11, 2021·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Mateus Pereira FunariEduardo Guimarães Hourneaux de Moura
Mar 17, 2021·Clinical Endoscopy·Phonthep Angsuwatcharakon, Rungsun Rerknimitr
Oct 20, 2021·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Antonio FacciorussoJacques Devière

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