Endoscopic Lithotripsy of Bile duct stones by using a Pulsed-Dye Laser.

After the development of EST, various kinds of Lithotripsy has been used for fragmentation of large bile duct stones that can't be extracted by Basket catheter. Several centers have reported success in bile stone fragmentation and removal via percutaneously or via transpapillary by using various techniques. (mechanical stone extraction, ultrasonic lithotripsy, electrohydraulic lithotripsy, Nd: YAG laser) Some reports suggested that there was possibility of bile duct damage by using EHL or Nd:YAG laser.In our hospital, almost of CBD stone was extracted by using Basket catheter or MHL. But 3% of cases has been adapted to EHL.(guided by PTCS or PCPS) In this report, five cases with large bile duct stones were treated successfully with pulsed-dye laser.(Two cases were guided by PCPS, three cases were guided by PTCS.) Lithotripsy was performed under direct vision with choledochoscopes, and there were no significant complications.Pulsed-dye laser is thought to effect fragmentation by laser light absorption onto the stone surface. The light may initiate a plasma on the stone surface that can rapidly expand and collapse, initiating a mechanical shock wave that has less bile duct injury. Pulsed-dye laser seems to be safe and effective in endoscopically directed lithotripsy of large bile duct stones.