Wong John Ct, Tang Raymond Sy, Teoh Anthony Yb, Sung Joseph Jy, Lau James Yw
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong.
Endosc Int Open. 2017 Jan;5(1):E54-E58. doi: 10.1055/s-0042-118701.
Laser lithotripsy can effectively fragment complicated biliary stones, but current cholangioscopes are limited by fragility, restricted mobility or moderate visual resolution. The efficacy and safety of a new digital single-operator peroral cholangioscope to guide laser lithotripsy were evaluated. In this prospective single-center series, consecutive patients with complicated biliary stones, defined as impacted stones > 1.5 cm in size and wider than the more distal common bile duct, or stones that failed extraction by basket mechanical lithotripsy, underwent ERCP and SpyGlass DS peroral cholangioscope (Boston Scientific, Marlborough, United States)-guided laser lithotripsy. Stone clearance rate and incidence of adverse events were determined. Seventeen patients (10 men, 7 women; median age 76 years) with a median biliary stone size of 2 cm underwent predominantly holmium:yttrium aluminum garnet laser lithotripsy, achieving a 94 % stone clearance rate over 1 median procedure. Lithotripsy was performed in 8 of 17 patients due to an impacted biliary stone. The remaining patients underwent lithotripsy due to prior failure of the basket mechanical lithotripter to capture or crush their stones. Post lithotripsy, 2 patients developed cholangitis and 1 patient with underlying COPD developed respiratory distress, all resolved with conservative management. There were no hemobilia, perforations, pancreatitis nor any deaths. SpyGlass DS peroral cholangioscopy-guided laser lithotripsy is an efficient and safe modality for management of complicated biliary stones.
激光碎石术能够有效击碎复杂胆管结石，但目前的胆管镜受限于易碎性、活动受限或中等视觉分辨率。我们评估了一种新型数字单操作者经口胆管镜引导激光碎石术的疗效和安全性。在这个前瞻性单中心系列研究中，连续纳入患有复杂胆管结石的患者，这些结石被定义为大小>1.5厘米且比更远端的胆总管更宽的嵌顿结石，或经网篮机械碎石术无法取出的结石，患者接受了内镜逆行胰胆管造影术（ERCP）以及由SpyGlass DS经口胆管镜（美国马萨诸塞州马尔伯勒市波士顿科学公司）引导的激光碎石术。确定结石清除率和不良事件发生率。17例患者（10例男性，7例女性；中位年龄76岁），中位胆管结石大小为2厘米，主要接受钬:钇铝石榴石激光碎石术，在1次中位手术中结石清除率达到94%。17例患者中有8例因嵌顿性胆管结石接受碎石术。其余患者因之前网篮机械碎石器未能捕获或粉碎结石而接受碎石术。碎石术后，2例患者发生胆管炎，1例患有慢性阻塞性肺疾病（COPD）的患者出现呼吸窘迫，所有这些均通过保守治疗得到缓解。未发生胆道出血、穿孔、胰腺炎，也没有死亡病例。SpyGlass DS经口胆管镜引导激光碎石术是治疗复杂胆管结石的一种有效且安全的方式。
