Laser Lithotripsy of Difficult Bile Duct Stones Under an Integrated Automatic Stone-Tissue Detection System
Abstract
We report our preliminary experience in the treatment of 16 CBD stone patients with a combination of ERCP with EST and rhodamine-6G dye laser (wavelength 595 nm) with an integra ted automatic stone-tissue detection system. More than half (56.2%) of the patients had previous abdominal operations, whereas 37.5% had choledochotomy. Laser fibers were controlled by fluoroscopy only (blind technique). The laser energies used were 80-120 m] and 5-8 Hz frequency. The sizes of stone ranged from 1.5 to 4.5 cm with an average of 2.7t1.0 cm. Laser lithotripsy resulted in successful fragmentation of stones in 14 of l6 patients (87.5%).
In case of severe acute cholangitis (25%), temporary drainage by endoprosthesis in the CBD and appropriate adjunct therapeutic measures were used. After the infection subsided, usually one week, definitive laser treatment was then performed. The 30-day mortality rate was zero. We conclude that laser lithotripsy is an effective and safe treatment in a highly selected patient of difficult bile duct stones with considerable surgical risk.
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