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To date no clinic trials have reported on the safety and effectiveness of the use of a frequency-doubled double pulse neodymium YAG (FREDDY) laser with a radiopaque mark under fluoroscopic guidance to treat bile duct stones that are untreatable by conventional endoscopic therapy. We report the cases of 30 patients with impacted or large common bile duct (CBD) stones (> 1.5 cm) treated by endoscopic lithotripsy using FREDDY laser with a radiopaque mark under fluoroscopic guidance. During the procedure, the tip of the laser fiber was packaged with a radiopaque ring mark that was detectable by fluoroscopy. In these patients, complete bile duct clearance was achieved in 27 of the 30 patients (90 %). The majority of patients (18/30) were treated in a single session; the mean number of sessions needed to clear the bile ducts completely was 1.4 ± 0.6. Adverse events were noted in two patients, who both developed acute mild pancreatitis.

Background Combined androgen blockade (cab) is a promising treatment modality for prostate cancer (pca). In the present meta-analysis, we compared the efficacy and safety of first-line cab using an antiandrogen (aa) with castration monotherapy in patients with advanced pca.Methods PubMed, embase, Cochrane, and Google Scholar were searched for randomized controlled trials (rcts) published through 12 December 2016. Hazard ratios (hrs) with 95% confidence intervals (cis) were determined for primary outcomes: overall survival (os) and progression-free survival (pfs). Subgroup analyses were performed for Western compared with Eastern patients and use of a nonsteroidal aa (nsaa) compared with a steroidal aa (saa).Results Compared with castration monotherapy, cab using an aa was associated with significantly improved os (n = 14; hr: 0.90; 95% ci: 0.84 to 0.97; p = 0.003) and pfs (n = 13; hr: 0.89; 95% ci: 0.80 to 1.00; p = 0.04). No significant difference in os (p = 0.71) and pfs (p = 0.49) was observed between the Western and Eastern patients. Compared with castration monotherapy, cab using a nsaa was associated with significantly improved os (hr: 0.88; 95% ci: 0.82 to 0.95; p = 0.0009) and pfs (hr: 0.85; 95% ci: 0.73 to 0.98; p = 0.007)—a result that was not achieved with cab using a saa. The safety profiles of cab and monotherapy were similar in terms of adverse events, including hot flushes, impotence, and grade 3 or 4 events, with the exception of risk of diarrhea and liver dysfunction or elevation in liver enzymes, which were statistically greater with cab using an aa.Conclusions Compared with castration monotherapy, first-line cab therapy with an aa, especially a nsaa, resulted in significantly improved os and pfs, and had an acceptable safety profile in patients with advanced pca.