Fluoroscopically guided laser lithotripsy of a pancreatic duct stone.

A 54-year-old man with early stage chronic pancreatitis and an impacted ductal stone in the pancreatic head complicated by a 2 cm abscess was treated with pulsed dye laser lithotripsy using an automatic stone tissue differentiation system under fluoroscopic control. This system automatically switches off the laser on contact with tissue. The 0.25 mm quartz fiber introduced into the pancreatic duct via a 5 French teflon catheter delivered 165 out of 1000 pulses at contact with the stone (100 mJ, 10 Hz). Partial stone disintegration was achieved making mechanical stone removal possible which initially failed. No major side-effect occurred. This new laser with a stone detection system seems to render fluoroscopically guided laser lithotripsy in the pancreatic duct safer thus warranting further clinical trials.