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Application of a novel 4.5F electrohydraulic lithotripsy probe for complex biliary stone fragmentation: a case series
Kanika Garg1, Thomas J Wang1, Agnieszka Maniak1
1Division of Digestive Diseases and Nutrition, Center for Interventional and Therapeutic Endoscopy, Rush University Medical Center, Chicago, Illinois, USA.
Background And Aims:
Large biliary stones (>25 mm) present significant therapeutic challenges, with standard endoscopic techniques frequently failing to achieve complete ductal clearance. Conventional 3F electrohydraulic lithotripsy (EHL) probes often require multiple sessions or result in incomplete fragmentation. We present a novel approach using a 4.5F EHL probe (Walz Elektronik GmbH, Rohrdorf, Germany) for successful management of large refractory biliary stones.
Methods:
Three female patients (aged 57, 59, and 67 years) with large biliary stones (35-45 mm) previously refractory to standard techniques underwent direct cholangioscopy with a 4.5F EHL probe fragmentation using an 11F cholangioscope (eyeMAX; Micro-Tech, Ann Arbor, Mich, USA). The 4.5F probe delivers energy up to 950 mJ with greater surface area contact than standard 3F probes.
Results:
Complete ductal clearance was achieved in all 3 cases within a single session, with successful fragmentation where conventional techniques had failed. Procedure durations ranged from 49 to 94 minutes. No adverse events occurred in any case.
Conclusions:
The 4.5F EHL probe represents a significant advancement for managing large refractory biliary stones, potentially reducing repeat procedures and obviating surgical intervention.
