A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave

Veld, Joyce V.; Huijgevoort, Nadine C.M. van; Boermeester, Marja A.; Besselink, Marc G.; Delden, Otto M. van; Fockens, Paul; Hooft, Jeanin E. van

doi:10.1055/a-0637-8806

Cited by 53 publications

(34 citation statements)

References 50 publications

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“…In this retrospective study, 42 patients with difficult biliary stones underwent LCBDE with FREDDY laser lithotripsy; all patients completed bile duct stone clearance, no bile duct mucosa bleeding and perforation cases were observed during the operation, and no post‐operative death occurred. Compared with the results of previous meta‐analyses, the ductal clearance rate of LCBDE with FREDDY laser lithotripsy (100%) in our study is higher than in those treated with EHL (88.4%) and ESWL (84.5%). However, the complication rate for the cases treated with LCBDE with FREDDY laser lithotripsy was lower than for the cases with EHL (13.8%) and ESWL (8.4%).…”

Section: Discussioncontrasting

confidence: 79%

“…In a recent meta‐analysis retrospective study on the clinical role of EHL, laser lithotripsy and ESWL in patients with retained biliary tract stones, the results showed that laser lithotripsy appeared to be the most successful advanced endoscopy‐assisted lithotripsy technique for retained biliary tract stones. Moreover, a significantly lower post‐procedural complication rate was found for laser lithotripsy and ESWL when compared with EHL …”

Section: Discussionmentioning

confidence: 94%

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Clinical role of frequency‐doubled double‐pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration

Yang

et al. 2019

ANZ Journal of Surgery

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Background: The optimal methods for patients with difficult biliary stones remain under debate. The aim of this study was to evaluate the role of frequency-doubled double-pulse neodymium YAG (FREDDY) laser lithotripsy for removing difficult biliary stones during laparoscopic common bile duct exploration (LCBDE). Methods: Between March 2013 and January 2015, 42 consecutive patients with difficult biliary stones who underwent LCBDE with FREDDY laser lithotripsy were included in this study. The clinical data of all patients were retrospectively collected and analysed. Results: Bile ducts were completely cleared in all patients. The complications related to laser lithotripsy were not noted. A total of 38 patients (90.5%) underwent primary closure of common bile duct, and T-tube drainage was applied to four patients (9.5%). No bile duct injury, bleeding and perforation were observed. There were no post-operative surgery-related deaths. Bile leakage occurred in four patients (9.5%) with primary closure procedure, and all of them were managed successfully with conservative therapy. The median follow-up period was 42.8 months, with no evidence of bile duct stricture and stone recurrence in all patients. Conclusions: The LCBDE combined with FREDDY laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 94%

Clinical role of frequency‐doubled double‐pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration

Yang

et al. 2019

ANZ Journal of Surgery

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“…EHL is commonly used in clinic, and its generated high-amplitude frequency hydraulic pressure waves could produce high energy that is absorbed by stones aiding in the disintegration of calculus 16,17 . In management of refractory biliary calculi, conventional EHL has difficulties in dealing with them efficiently, due to their peculiar consistency, size, location, and so on 18 . The low efficiency of EHL, on the one hand, leads to increased POC duration, and extra POC interventions; on the other hand, results in prolonged T-tube retaining time, and accessorial treatment costs 19 .…”

Section: Discussionmentioning

confidence: 99%

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

Wen¹,

Ren²,

Wang³

et al. 2020

Sci Rep

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Although postoperative cholangioscopy (POC) guided electrohydraulic lithotripsy (EHL) is considered to be a conventional technique for residual biliary calculi, its efficacy still needs to be improved to fit in the managemet of refractory calculi. This study evaluated the efficacy and safety of combined lithotripsy of mechanical clamping and electrohydraulics in fragmentation and removal of refractory calculi. Totally, 281 patients, who suffered from residual biliary calculi after hepatectomy and underwnet POC from August 2016 to June 2018 were involved. The first 128 patients were subjected to conventional EHL, and later consective 153 to combined lithotripsyof mechanical clamping and EHL. Perioperative data, technical information, treatment outcomes and follow-up results were collected. Clinical characteristics were statistically comparable (P > 0.05). The overall POC interventional sessions (2.0 ± 0.65 vs. 2.9 ± 1.21 sessions), average operating time (99.1 ± 34.88 vs. 128.6 ± 72.87 minutes), incidence of intraoperative hemobilia (4.58% vs. 10.93%), cholangitis (6.54% vs. 14.06%), postoperative complications (10.45% vs. 21.87%), T-tube retaining time after first POC (20.7 ± 5.35 vs. 28.1 ± 8.28 days), and treatment costs ($2375 ± 661.72 vs. $3456.7 ± 638.07) were significantly lower in the combined lithotripsy group than those in the EHL group (P < 0.05). There were no differences between the two groups in calculi recurrence at half-a year, or one year follow-up. In conclusion, combined lithotripsy of mechanical clamping and electrohydraulics can safely and effectively benefit postoperative patients along with refractory residual biliary calculi. Although biliary calculus is a benign disease characterized for the presence of intrahepatic bile duct calculi, it may cause serious complications 1,2. Hepatectomy combined with intraoperative cholangioscopy is regarded as the most helpful approach not only for the removal of the intrahepatic calculi and lesions, but also for reducing the risk of calculi recurrence and cholangitis 3. Unfortunately, this technique is not suitable for complicated calculi distributing bilobarly or diffusely 4. In management of complicated calculi, placement of a T-tube drainage for further postoperative cholangioscopy (POC) was feasible, which allows for repeated sessions for calculi extraction 5,6. When dealing with complicated residual biliary calculi such as with large size, hard consistency, or anatomical abnormalities, conventional POC managements including perfusion and basket extraction are often difficult, or even impossible in patients with impacted calculi 7. Among advanced therapeutic strategies including electrohydraulic lithotripsy (EHL), laser lithotripsy, pneumatic lithotripsy and hyperacoustic lithotripsy, the EHL being the most commonly used in clinic because of its efficiency and low costs 8-11. It allows calculi to be crushed by energy absorption, which leads to a build-up of pressure gradients and the formation of shear and tear forces 9 .

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“…However, some intractable calculi are unable to be fragmented despite long‐term exposure to repeated EHL with high voltage . Furthermore, the diffused energy may cause persistent damage to the wall of the bile duct, which results in serious complications . Herein, we introduce a new clamping‐assisted EHL (CEHL) method to achieve efficient fragmentation of intractable calculi (Video S1).…”

Section: Brief Explanationmentioning

confidence: 99%

Efficient clearance of intractable biliary calculi by combination of mechanical clamping and electrohydraulic lithotripsy

Wen

Ren

Liu

2019

Digestive Endoscopy

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A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave

Abstract: This systematic review revealed that laser lithotripsy appeared to be the most successful advanced endoscopy-assisted lithotripsy technique for retained biliary tract stones, although randomized studies are lacking.

Cited by 53 publications

References 50 publications

Clinical role of frequency‐doubled double‐pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration

Clinical role of frequency‐doubled double‐pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

Efficient clearance of intractable biliary calculi by combination of mechanical clamping and electrohydraulic lithotripsy

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