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• W2912723023 abstract "Laser lithotripsy is being increasingly utilized to remove difficult to treat common bile duct (CBD) stones. These procedures are usually performed at referral centers that have the equipment and volume of patients to perform these procedures. We describe a case of a patient with a retained CBD stone that failed multiple types of treatment, but was finally dissolved through a collaborative effort of the departments of Gastroenterology, Urology, and Radiology. This is a 58 year-old man with a history of cholelithiasis for thirty years. Eleven months ago, he was admitted to an outside hospital for febrile jaundice. An ultrasound revealed intra- and extrahepatic duct dilatation, several small stones in the cystic duct and a large stone in the CBD. Endoscopic retrograde cholangiopancreatography (ERCP) restored some flow in the CBD, but the CBD stone remained. He was scheduled for a repeat ERCP to attempt to remove the stone again, but he was lost to follow-up. Five months ago, he underwent a cholecystectomy, and was found to have a trapped CBD stone. An attempt by the surgeon to remove the stone through the percutaneous transhepatic drain was unsuccessful. The patient then came to our institution and had an ERCP with extension of the sphincterotomy. However, attempts to remove the stone with a trapezoid basket were unsuccessful. Next, extracorporal shock wave lithotripsy (ESWL) was performed, but without apparent fragmentation of the CBD stone. Finally, it was decided to perform laser lithotripsy. The gastroenterologist, urologist, and radiologist, working in collaboration, performed a percutaneous laser lithotripsy. Cholangiogram through the biliary catheter revealed a large CBD stone approximately 2 cm in size. With the guidance of fluoroscopy, a ureteral access catheter was inserted over a wire into the CBD. A ureteroscope was advanced into the CBD to the level of the stone. A 200 micron holmium laser fiber was used to perform lithotripsy. Pulverization of the stone was confirmed through a contrast study. Discussion: We demonstrate a case of successful laser lithotripsy on a difficult to remove CBD stone through a collaborative effort of Gastroenterology, Urology, and Radiology. Using this model, laser lithotripsy may be performed successfully not only in referral centers, but in community-based hospitals as well." @default.
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• W2912723023 date "2007-09-01" @default.
• W2912723023 modified "2023-09-26" @default.
• W2912723023 title "Laser Lithotripsy for Removal of a Difficult To Treat Common Bile Duct Stone: A Collaborative Effort among Gastroenterology, Urology, and Radiology Departments" @default.
• W2912723023 doi "https://doi.org/10.14309/00000434-200709002-00833" @default.
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