Clinical utility of peroral cholangioscopy in the treatment of intrahepatic stones

Abstract

Hepatolithiasis has been a challenging condition in the treatment. Peroral cholangioscopy could have a potentiality favorable to the less invasive treatment of hepatolithiasis, because the access to bile ducts, usually through the duodenal papilla, is always ready when once available.
We performed peroral cholangioscopic lithotripsy in 23 patients with intrahepatic st o nes. For stone fragmentation under the direct vision of the cholangioscope, an electrohydraulic pressure was applied in 16 patients, a Nd: YAG laser in one and a flashlamp-pumped dye laser in one.
Intrahepatic stones were smashed when the cholangioscope was accessible. Total clearance of intrahepatic bile ducts was achieved in 14 patients, partial clearance in 7. The two failures had a severe stricture in the bile duct which did not allow the instrument to pass. There were no remarkable complications; in only one case minor hemobilia occurred during electrohydraulic pressure lithotripsy. All successful patients were well without biliary complaints during the follow up period of three to 55 months after the procedure had completed.
Peroral cholangioscopic lithotripsy should be a safe and effective method in the treatment of intrahepatic stones.