[Treatment of complex biliary stones by cholangioscopy laser lithotripsy in 10 patients]

To describe the efficacy and safety of laser lithotripsy during peroral cholangioscopy for the treatment of complex biliary stones.

Prospective, descriptive study.

Data were prospectively collected on all patients referred over a period of two years for peroral cholangioscopic laser lithotripsy following failure of endoscopic retrograde cholangiopancreatography (ERCP). The efficacy and safety of the treatment were studied.

Eleven patients were treated. ERCP with stone removal and mechanical lithotripsy had been undertaken previously in these patients, but was unsuccessful. In one patient, lithotripsy was not performed because the endoscope could not be positioned satisfactorily. This patient was operated. Ten patients were treated with laser lithotripsy. In 9 of the 10 patients lithotripsy led to complete removal of all stone. In one patient the stone extraction partially failed. One complication occurred, a rupture of the common bile duct which could be managed conservatively by a stent.

Peroral cholangioscopy guided laser lithotripsy of biliary stones appears to be a safe and effective treatment in patients in whom initial ERCP and mechanical lithotripsy is unsuccessful.