LASER LITHOTRIPSY OF DIFFICULT BILE-DUCT STONES - RESULTS IN 60 PATIENTS USING A RHODAMINE 6G DYE-LASER WITH OPTICAL STONE TISSUE DETECTIONSYSTEM

Introduction-Laser lithotripsy of bile duct stones has become a widely accepted endoscopic treatment modality for giant, impacted, or very h ard stones. The procedure is usually carried out under direct endoscop ic control in view of the potential risk of bile duct injuries in ''bl ind'' laser application. Aims-To investigate the use of a rhodamine 6G laser lithotriptor with an integrated optical stone tissue detection system (oSTDS). Methods-From 1 September 1991 to 7 March 1997, 60 pati ents with giant or impacted common bile duct stones refractory to endo scopic papillotomy stone extraction, and mechanical lithotripsy were t reated via the endoscopic retrograde route using a rhodamine 6G dye la ser (595 nm, 2.5 mu s, 80-150 mJ pp, Lithognost Telemit/Baasel Corp., Germany) with integrated oSTDS. In case of tissue contact oSTDS cuts o ff the laser pulse after 190 ns (transmission of 5-8% of the total pul se energy). 47 patients (78.3%) were subjected to x ray targeting (oST DS) alone, five (8.3%) to choledochoscope targeting alone, and eight ( 13.3%) to both techniques. Results-At the end of treatment 52 (87%) pa tients were completely stone-free. The only major complications includ ed transient haemobilia, cholangitis, and pancreatitis in five patient s. All five were successfully treated by conservative methods. Conclus ions-Laser lithotripsy using the described rhodamine 6G dye laser with oSTDS seems to be safe and effective and allows ''blind'' fragmentati on of difficult common bile duct stones under radiological control onl y.