The management of difficult pancreatobiliary duct stones remains challenging, particularly in patients with large or impacted stones, unfavorable anatomy, or prior failed endoscopic interventions. Peroral cholangioscopy-guided laser lithotripsy has emerged as a promising therapeutic approach; however, real-world data from consecutive single-center experiences are limited. This study aimed to describe the technical feasibility, procedural outcomes, and safety of cholangioscopy-guided laser lithotripsy in patients with difficult pancreatobiliary duct stones. This retrospective single-center study included a consecutive series of 16 patients with difficult pancreatobiliary duct stones who underwent peroral cholangioscopy-guided Holmium:YAG laser lithotripsy after unsuccessful conventional endoscopic extraction. Technical success, complete duct clearance, procedural characteristics, and adverse events were analyzed. Technical success was achieved in all patients (100%; exact 95% CI 79.4–100%), with complete duct clearance obtained in a single session in all cases.The median procedure time was 70 min (IQR 59–85; range 50–130). All patients had undergone prior ERCP attempts, with a median of 2 previous procedures. Adverse events occurred in 3 patients (18.7%) and were all mild, including post-procedural pain (12.5%) and mild post-ERCP pancreatitis (6.2%). No severe complications, such as perforation, clinically significant bleeding, or cholangitis, were observed. In this small, heterogeneous single-center series, cholangioscopy-guided laser lithotripsy was technically feasible and was associated with complete duct clearance in a single treatment session in all patients, with only mild adverse events observed. These findings provide descriptive data supporting the potential role of this technique in selected patients with difficult pancreatobiliary duct stones, particularly after unsuccessful conventional endoscopic interventions.
Karpuz et al. (Mon,) studied this question.