Choosing Between Aggressive Treatments for Difficult Bile Duct Stones

Although most bile duct stones are easily removed via biliary sphincterotomy and balloon extraction, about 10% require more-aggressive treatments, including endoscopic balloon dilation of the bile duct, mechanical lithotripsy, laser lithotripsy, and electrohydraulic shock wave lithotripsy (used alone or in combination). To date, few studies have compared these advanced modalities.

Now, investigators have conducted a randomized study to compare the effectiveness of cholangioscopy-guided laser lithotripsy versus mechanical lithotripsy to remove large bile duct stones in 32 patients who had failed treatment with endoscopic balloon dilation of the bile duct. Patients assigned to either modality could cross over to the other study arm in the even…