COMMENTARY
See article on page 823
Does laser lithotripsy hit the target?
| The first 150 words of the full text of this article appear below. |
Ever since it was generally concluded that endoscopic
retrograde cholangiopancreatography (ERCP) and sphincterotomy was
the treatment of choice for choledocholithiasis, big bile duct stones have remained a major challenge for the endoscopist. Extending a
sphincterotomy increases risk of bleeding and perforation, mechanical lithotripters are generally expensive, cumbersome to use, fragile, and
fail to grasp the stones effectively in a significant proportion of
cases. Intraduct solvents such as mono octanoin or methyl tert butyl
ether are ineffectual or dangerous, or both. The somewhat defeatist
approach of placing stents in elderly patients can lead to stent
migration with occasional serious consequences or the formation of
multiple stones above the stent, with the consequent risk of further
cholangitis. There is probably a place at a few referral centres for
extracorporeal shock wave lithotripsy (ESWL) but this requires some
sort of biliary catheter to deliver x ray contrast medium
to facilitate targeting, which usually
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- Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system
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Gut 1998 43: 823-829.[Abstract] [Full Text] [PDF]
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