7082 Pancreatoscopic laser lithotripsy (psll) of pancreatic duct stoned.

Abstract

Introduction: We report the result of pancreatoscopic laser lithotripsy (PSLL) of pancreatic duct stones (PDS). Subjects and Methods: The subjects were 21 patients (18 male, 3 female) with pancreatitis by PDS at our department between 1993 and 1999. The laser used in this study was a flashlamp-pumped pulsed dye laser with a wavelength of 504nm. The laser energy was transmitted via a 320μm flexible quartz fiber. The pancreatoscope was a 1.67mm miniscope with an inner channel 0.55mm in diameter. This miniscope inserted with a 7Fr plastic sheath through a standard duodenoscope was used for transpapillary laser application under direct vision of PDS. The laser energy was transmitted to PDS through the fine laser fiber inserted via the channel. The laser pulses were applied at a repitation rate of 10Hz and an energy output of 30mJ. If the stones fragmented too slowly the energy was increased up to 100mJ provied precise targeting of PDS could be achieved. Extracorporeal shock wave lithotripsy (ESWL) was applied to the cases in which PDS could not be disintegrated completely by PSLL alone. According to therapeutic procedure, all patients were classified into three groups: PSLL group, combination (PSLL and ESWL) group, and ESWL group. We evaluated number and diameter of PDS, treatment period, total number of sessions, relief of pain and clearance of PDS for each group. Conclusion: PSLL is a very useful and effective technique in the treatment of symptomatic PDS.