[Laser Lithotripsy by Direct Peroral Cholangioscopy in Complicated Biliary Lithiasis: A Case Series]

Common bile duct stones are usually resolved with an endoscopic retrograde cholangiopancreatography. Sometimes, choledocholithiasis becomes a therapeutic challenge, either due to the morphology of the stones, their size, consistency and their relationship with the common bile duct diameter and anatomy. Giant choledocholithiasis poses a therapeutic challenge. Fortunately, we increasingly have more tools for its endoscopic management. Among them we mention, mechanical basket lithotripsy, extracorporeal lithotripsy, and Cholangioscopy guided lithotripsy, electrohydraulic o laser. We present 2 cases of giant choledocholithiasis treated with cholangioscopy-guided laser litotricia. The first case is a 70-year-old female patient with a history of a cholecystectomy 10 years ago. She was referred to our hospital from another institution for giant choledocholithiasis with two failed endoscopic retrograde cholangiopancreatography attempts. The second patient is a 58-year-old male patient, also with previous cholecystectomy with 1 previous attempt at endoscopic retrograde cholangiopancreatography for giant choledocholithiasis without success.Both patients were successfully treated through cholangioscopy-guided laser lithotripsy in a single session and were discharged one day after the procedures.