Flexible Percutaneous Laser Lithotripsy for Intrahepatic Stones: A Multicenter Study in Western Patients

Area of Science:

• Interventional Radiology
• Gastroenterology
• Biliary Endoscopy

Background:

• Intrahepatic lithiasis (IHL) presents significant challenges, particularly in patients with surgically altered biliary anatomy or those who have undergone failed endoscopic interventions.
• Percutaneous laser lithotripsy (PLL) guided by flexible cholangioscopy is an emerging minimally invasive option for complex intrahepatic stones.

Purpose of the Study:

• To assess the efficacy and safety of flexible PLL for treating intrahepatic stones.
• Focus on a multicenter Brazilian cohort with challenging anatomies or prior failed ERCP.

Main Methods:

• Primary outcome: technical success defined by complete ductal clearance (cholangioscopy/MRI at 1 month).
• Clinical success: symptom resolution without recurrence or re-intervention.
• Secondary outcomes: number of sessions, complications, and recurrence rates.

Main Results:

• 100% technical success with an average of 1.29 sessions per patient.
• Minor complications in 11.4%; no major adverse events, bile duct injuries, or deaths.
• No symptomatic recurrence during a mean 14.7-month follow-up.
• Cholangioscopy identified incidental biliary polyps, one with low-grade dysplasia, missed by preprocedural imaging.

Conclusions:

• Flexible PLL is a safe, effective, and reproducible method for complex IHL, particularly in patients with altered anatomy or failed endoscopic therapy.
• The technique offers added diagnostic value and supports potential outpatient protocols with disposable cholangioscopes.
• Broader adoption in interventional radiology is supported by its efficacy and diagnostic yield.