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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2008; 14(18): 2863-2866
Published online May 14, 2008. doi: 10.3748/wjg.14.2863
Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser
Tae Hyeon Kim, Hyo Jeong Oh, Chang-Soo Choi, Dong Han Yeom, Suck Chei Choi
Tae Hyeon Kim, Hyo Jeong Oh, Chang-Soo Choi, Dong Han Yeom, Suck Chei Choi, Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan 570180, Korea
Author contributions: Kim TH designed research plan and wrote the paper; Oh HJ and Choi CS performed research; Yeom DH and Choi SC analyzed data.
Correspondence to: Hyo-Jeong Oh, MD, Department of Internal Medicine, Wonkwang University School of Medicine, Sinyong Dong 344-2, Iksan 570-180, Korea. kth@wonkwang.ac.kr
Telephone: +82-63-8592670
Fax: +82-63-8552025
Received: January 19, 2008
Revised: April 10, 2008
Published online: May 14, 2008
Abstract

AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique.

METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter.

RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis).

CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

Keywords: Bile duct stones, Frequency doubled double pulse Nd:YAG laser, Transpapillary removal, Mechanical lithotripsy, Balloon catheter