Laser Lithotripsy vs. Conventional Therapy for Complex Bile Duct Stones

Approximately 90% of common bile duct stones can be removed by conventional biliary sphincterotomy and balloon extraction during endoscopic retrograde cholangiopancreatography (ERCP). The remainder are so-called “complex” bile duct stones that may require more aggressive endoscopic removal techniques, including mechanical lithotripsy, electrohydraulic lithotripsy, or laser lithotripsy, which can be used alone or in combination.

Investigators have now evaluated 60 patients with large bile duct stones (>1 cm) who were randomized 2:1 to undergo cholangioscopy-guided laser lithotripsy or conventional therapy; mechanical lithotripsy was permitted in both study arms.

Endoscopic clearance was achieved in a greater proportion of patients who underwen…