scholarly journals Laser Lithotripsy — The New Wave

1990 ◽  
Vol 4 (9) ◽  
pp. 632-636 ◽  
Author(s):  
J Hochberger ◽  
C Ell
Keyword(s):  
Shock Wave ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Tissue Damage ◽  
Nd:Yag Laser ◽  
Laser Lithotripsy ◽  
Endoscopic Retrograde ◽  
Endoscopic Papillotomy ◽  
Nanosecond Pulses ◽  
Extracorporeal Shock Wave

Currently more than 90% of all common bile duct concrements can he removed via the endoscopic retrograde route by means of endoscopic papillotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones however often st ill resist conventional endoscopic therapy. Laser lithotripsy represents a promising new endoscopic approach to the nonsurgical treatment of those common bile duct stones. Currently only short-pulsed laser systems with high power peaks but low potential for thermal tissue damage are used for stone fragmentation. Systems in clinical applications are the pulsed free-running-mode neodymium YAG (Nd:YAG) laser (1064 nm, 2 ms) and the dye laser (504 nm, 1 to 1.5 μs). Energy transmission via highly flexible 200 ìm quartz fibres allows an endoscopic retrograde approach to the stone via conventional duodenoscope or mother-baby-scope systems. New systems currently in preclinical and first clinical testing are the Q-switched Nd:YAG laser (1064 nm, 20 ns) and the Alexandrite laser (700 to 815 nm, 30 to 500 ns). By means of extremely short nanosecond pulses (10-9s) for the induction of local shock waves at the stone surface, possible tissue damage is even more reduced. No complications have been reported so far after applying laser lithotripsy clinically in about 120 patients worldwide. Compared to extracorporeal shock wave treatment, laser lithotripsy can be executed in any endoscopy unit in the scope of the endoscopic pretreatment and does not require general anesthesia, which is often necessary for extracorporeal shock wave lithotripsy.

scholarly journals Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

2007 ◽  
Vol 44 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Ralf Jakobs ◽  
Julio C. Pereira-Lima ◽  
Aline W. Schuch ◽  
Lucas F. Pereira-Lima ◽  
Axel Eickhoff ◽  
...  
Keyword(s):  
Bile Duct ◽  
Laser Lithotripsy ◽  
Bile Duct Stones ◽  
Distal Bile Duct ◽  
Laser Guidance ◽  
Endoscopic Papillotomy ◽  
Intrahepatic Stones ◽  
Bile Duct Stenosis ◽  
Extracorporeal Shock Wave ◽  
Fluoroscopic Control

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

Long-Term Follow-Up After Treatment of Common Bile Duct Stones by Extracorporeal Shock-Wave Lithotripsy

Endoscopy ◽  
1996 ◽  
Vol 28 (05) ◽  
pp. 411-417 ◽  
Author(s):  
C. Meyenberger ◽  
U. Meierhofer ◽  
C. Michel-Harder ◽  
J. Knuchel ◽  
H. P. Wirth ◽  
...  
Keyword(s):  
Shock Wave ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Shock Wave Lithotripsy ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Extracorporeal Shock Wave ◽  
Long Term Follow Up

scholarly journals Safety and efficacy of extracorporeal shock wave lithotripsy for difficult-to-retrieve common bile duct stones: A ten-year experience

2020 ◽  
Vol 8 (3) ◽  
pp. 159-164
Author(s):  
Muhammad Manzoor ul Haque ◽  
Nasir Hassan Luck ◽  
Abbas Ali Tasneem ◽  
Syed Mudassir Laeeq ◽  
Rajesh Mandhwani ◽  
...  
Keyword(s):  
Shock Wave ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Common Bile Duct Stones ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Electrohydraulic Lithotripsy ◽  
Extracorporeal Shock Wave

AbstractBackground and ObjectiveExtracorporeal shock wave lithotripsy (ESWL) for common bile duct (CBD) stones has been used in the past, but experience is limited. We report our experience of ESWL in the management of difficult CBD stones.MethodsPatients with difficult-to-retrieve CBD stones were enrolled and underwent ESWL. Fluoroscopy is used to target the stones after injection of contrast via nasobiliary drain. CBD clearance was the main outcome of the study.ResultsEighty-three patients were included (mean age 50.5 ± 14.5 years); these patients were mainly females (43; 51.8%). Large stones >15 mm were noted in 64 (77.1%), CBD stricture in 22 (26.5%) and incarcerated stone in 8 (9.6%) patients. Patients needed 2.1 ± 1.2 sessions of lithotripsy and 4266 ± 1881 shock waves per session. In 75 (90.3%) patients, the fragments were extracted endoscopically after ESWL, while spontaneous passage was observed in 8 (9.6%). Total CBD clearance was achieved in 67 (80.6%) patients, partial clearance in 5 (6%) and no response in 11 (13.2%). Failure of the treatment was observed in large stone with size ≥2 cm (P = 0.021), incarcerated stone (P = 0.020) and pre–endoscopic retrograde cholangiopancreatography cholangitis (P = 0.047).ConclusionESWL is a noninvasive, safe and effective therapeutic alternative to electrohydraulic lithotripsy and surgical exploration for difficult biliary stones.

scholarly journals Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system

Gut ◽  
1998 ◽  
Vol 43 (6) ◽  
pp. 823-829 ◽  
Author(s):  
J Hochberger ◽  
J Bayer ◽  
A May ◽  
S Mühldorfer ◽  
J Maiss ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Rhodamine 6G ◽  
Detection System ◽  
Common Bile Duct Stones ◽  
Laser Lithotripsy ◽  
Dye Laser ◽  
Bile Duct Stones ◽  
Endoscopic Papillotomy ◽  
Rhodamine 6G Dye

Introduction—Laser lithotripsy of bile duct stones has become a widely accepted endoscopic treatment modality for giant, impacted, or very hard stones. The procedure is usually carried out under direct endoscopic control in view of the potential risk of bile duct injuries in “blind” laser application.Aims—To investigate the use of a rhodamine 6G laser lithotriptor with an integrated optical stone tissue detection system (oSTDS).Methods—From 1 September 1991 to 7 March 1997, 60 patients with giant or impacted common bile duct stones refractory to endoscopic papillotomy stone extraction, and mechanical lithotripsy were treated via the endoscopic retrograde route using a rhodamine 6G dye laser (595 nm, 2.5 μs, 80–150 mJ pp, Lithognost Telemit/Baasel Corp., Germany) with integrated oSTDS. In case of tissue contact oSTDS cuts off the laser pulse after 190 ns (transmission of 5–8% of the total pulse energy). 47 patients (78.3%) were subjected tox ray targeting (oSTDS) alone, five (8.3%) to choledochoscope targeting alone, and eight (13.3%) to both techniques.Results—At the end of treatment 52 (87%) patients were completely stone-free. The only major complications included transient haemobilia, cholangitis, and pancreatitis in five patients. All five were successfully treated by conservative methods.Conclusions—Laser lithotripsy using the described rhodamine 6G dye laser with oSTDS seems to be safe and effective and allows “blind” fragmentation of difficult common bile duct stones under radiological control only.

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