Abstract
Background/Aim: Mechanical lithotripsy is the first choice for difficult stone resistant to conventional endoscopic treatment procedure. Although high success rate, mechanical lithotripsy can be failed or result in complications, especially in patients with large and hard stones. Laser lithotripsy (LL) with FREDDY is very effective and safe for stone fragmentation. Newly developed double-lumen basket for LL allows laser lithotripsy after capturing of stone by basket. The aim of this study was to evaluate the feasibility and efficacy of laser lithotripsy using double-lumen basket in patients with difficult bile duct stones. Methods: A total of twelve patients with CBD stones in whom conventional endoscopic treatment including mechanical lithotripsy had failed were selected and underwent FREDDY LL using a double-lumen basket. A laser fiber was inserted through the lumen of basket onto the stone surface after capturing of a stone by basket. LL was performed under fluoroscopy until possible to capture of fragmented stone into the basket. Endoscopic removal of fragments was attempted within the same session. Failure was defined as failure to remove all ductal stones/fragments within two lithotripsy sessions. Results: Stones were successfully fragmented in 11 of 12 patients; 11 patients (91.7%) eventually became stone free. Two of 11 patients (16.7%) required more than one session for LL. The mean number of endoscopic treatment sessions was 1.4 for complete stone removal. The fragments were extracted endoscopically after LL in all patients; mechanical lithotripsy was applied in 2/11 (16.7%) patients. Minor complications were noted in four patients (hemobilia in two patients, abdominal pain in two patients). Conclusion: For a selected group of patients with difficult CBD stones, FREDDY laser lithotripsy using double-lumen basket seems to be a safe and effective method. However, continuous development of basket for the better lithotripsy is needed.
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