Percutaneous Transhepatic Flexible Ureteroscope-Guided Frequency-Doubled Dual Pulse ND:YAG Laser Lithotripsy for Refractory Choledocholithiasis

Abstract ObjectivesTo evaluate the safety and efficiency of percutaneous transhepatic flexible ureteroscope-guided frequency-doubled dual pulse ND:YAG laser lithotripsy (PTFU-FREDDY) for refractory choledocholithiasis.MethodsFrom December 2017 to October 2018, 24 refractory choledocholithiasis patients with large common bile duct stones, anatomic variations, multiple stones or stones at difficult locations (impacted, above a biliary stricture) were admitted to two centers. Four patients were considered intolerant to surgery or endoscopic retrograde cholangiopancreatography (ERCP), and 2 had ERCP failure, the others refused. All patients underwent PTFU-FREDDY. Clinical success rate, recurrence of calculus, laser safety, and related complications, such as fever, haematoma, and local thermal damage were recorded. ResultsPatients’ mean age was 66.0±12.1 (43-89) years. Sex ratio was 1:1.2 (male: female). The mean diameter of stones was 21.8±2.4 mm. All stones were successfully broken and pushed into the duodenum. The mean lithotripsy frequency and procedure time of Bilirubin stones was higher than cholesterol stones, and the mixed were in middle，P<0.01. One patient（4.2%）had haemobilia, requiring immediate transarterial embolisation with 100mg 300-500um gelatin sponge particles. No pancreatitis, sepsis, or serious local thermal damage, such as bile duct perforation, was observed. The rates of Grade A/B of fever, abdominal pain, nausea, and vomiting were 12.5%, 12.5%, 8.3%, and 4.2% during follow-up, respectively. The recurrence was none at the endpoint of 12 months.Conclusion PTFU-FREDDY is a safe and effective alternative treatment for refractory choledocholithiasis, especially when traditional treatments fail or are difficult to perform.