Biliary - Choledocholithiasis Treated with Electrohydraulic Lithotripsy
Comments: This 89 year old lady was referred for ERCP following two failed prior attempts to remove multiple common bile duct stones. Note that the stones are facetted and tightly packed. The DACP scope is advanced into the distal common bile duct up to the first stone. Electrohydrolic lithotripsy or EHL is used here because of its proven efficacy in fragmenting resilient biliary stones and because the use a standard mechanical lithotripsy techniques had previously failed in this patient. The EHL probe is positioned in close opposition to the stone surface under liquid media. We use a saline irrigant. Firing is aimed at a single until that stone is fragmented. On the second stone, you can see the EHL probe firing at a single site, chipping away until that stone is split. When sufficient fragmentation occurs, using either a balloon or basket, the stone chips are removed from the bile duct. The DACP scope is then repositioned to continue with fragmentation. Care is taken to avoid contact with the EHL probe against the biliary epithelium. While EHL perforation of the bile duct has reported, it remains an uncommon complication. Once complete fragmentation has been achieved, the remaining stone chips can be removed from the bile duct using either a balloon or a basket. Note in this example, the retained gall bladder stones.
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Peter B. Kelsey, M.D. Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital |
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Citation: Kelsey, PB (Feb 21 2006). Biliary - Choledocholithiasis Treated with Electrohydraulic Lithotripsy. The DAVE Project. Retrieved Sep, 9, 2010, from http://daveproject.org/viewfilms.cfm?film_id=35 Times viewed since Feb 2006: 6828 |
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