Digital per-oral cholangioscopy with holmium laser lithotripsy to?manage complex biliary calculi

摘要

We present 3 cases that demonstrate the efficacy andsafety of holmium laser lithotripsy in the managementof complex biliary calculi. Digital per-oral cholangioscopyperformed under fluoroscopic and endoscopic controlallows direct visualization of calculi in the intrahepaticand extrahepatic biliary tree. A 200-micron lithotripsyfiber can be advanced down the 1.2-mm channelof the cholangioscope. Visualization is achieved with constant irrigation of normal saline solution (90-100 mL/min).Power settings of 10 watts (10 Hz, 1 joule) are safe to useand allow successful stone fragmentation.