Cholangioscopy-Assisted Laser Lithotripsy versus Electrohydraulic Lithotripsy (EHL) for Difficult Bile Duct Stones

Introduction: Although large biliary stones often require electrohydraulic lithotripsy (EHL), or holmium laser lithotripsy (LL), there have been very few studies comparing two methods. The purpose of this study was to compare the efficacy and safety of LL and EHL using cholangioscope.

Methods: We retrospectively analyzed 15 patients with bile duct stones who underwent LL or EHL between 2020 and 2023. All patients had failed clearance of common bile duct conventional methods of stone extraction and underwent biliary stent placement as salvage due to various factors such as, such as large stone (n = 10), impacted stone (n = 5), and underwent EHL or LL. All stones were extrahepatic in location. Furthermore, 5 patients (33.3%) had a single stone and 10 (66.7%) had multiple stones. The main outcome measures included complete stone clearance, procedure times, and postprocedure complications.

Results: Eight patients received LL and seven received EHL. The LL group had a significantly shorter procedure time and fewer sessions (EHL: 2.14, LL: 1.2,) than the EHL group. There were no significant differences in stone size (EHL: 14.8, LL: 14.6 mm) or stone location between the two groups. The rate of complete clearance was higher in the LL group (EHL: 85.7%, LL: 100%), although the difference was not statistically significant. The complication rate was lower in the LL group (EHL: 28.5%, LL: 12.5%), but the difference was also not statistically significant. The main complications included bleeding (n = 1), Cholangitis (n = 2), and there were no severe complications in either group.

Conclusion: LL was more effective and faster than EHL for large bile duct stones, requiring fewer ERCP sessions. Both methods were safe and well tolerated, with no severe complications. LL may be a better option than EHL for large bile duct stones.

Outcome	LL group	EHL group	p-Value
Sessions	1.2	2.14	0.03
Mean procedure time (minutes)	95.5	62.5	0.02
Complication rates	12.5%	28.5%	0.88

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Publikationsverlauf

Artikel online veröffentlicht:
22. April 2024