Potential of intraductal contact lithotripsy with oral cholangioscopy in the treatment of ”complex” choledocholithiasis

Abstract

   Aim. To evaluate the efficacy of various methods of intraductal contact lithotripsy in “complex” choledocholithiasis.   Materials and methods. From January 2018 to July 2023, 40 patients underwent intraductal contact lithotripsy with oral transpapillary cholangioscopy. Indications for the procedure included failure of mechanical lithotripsy in large choledocholithiasis in 37 patients (92.5 %), impaction of the gallstone during conventional lithoextraction, narrow pancreatic part of common bile duct, intrahepatic localization of gallstones. Contact electrohydraulic lithotripsy was performed in 10 patients (25 %), laser fragmentation by holmium laser in 15 patients (37.5 %), and new thuliumlaser – in 15 patients (37.5 %).   Results. The overall efficacy of contact lithotripsy methods comprised 90%. Laser methods demonstrated comparable results: the overall success rate of lithotripsy with holmium laser accounted for 93.3 %, and with thulium laser – 90 %. Complete sanitation after the first intervention with holmium lithotripsy was achieved in 92.9 % of patients, with thulium laser – in 88.9 %. The efficacy of electrohydraulic lithotripsy was lower: the overall success rate comprised86.7 %, and the success rate after the first procedure accounted for 61.5 % of patients. The average number of interventions required to achieve complete sanitation of the bile ducts amounted to 1.07 for holmium laser lithotripsy,1.1 for thulium laser, and 1.6 for electrohydraulic lithotripsy. In 1 case (2.5 %), perforation of the wall of the common bile duct was noted during the extraction of stone fragments. The complication was corrected during retrograde intervention. No fatal outcomes reported.   Conclusion. Intraductal contact lithotripsy proved to be highly effective and safe. Laser methods demonstrate certain advantages over electrohydraulic lithotripsy.