Peroral cholangioscopy with thulium laser lithotripsy in complicated choledocholithiasis

Aim. To assess the initial experience of peroral cholangioscopy with thulium laser lithotripsy in complicated choledocholithiasis. Materials and methods. Between 2021 and 2024, 14 patients underwent peroral cholangioscopy with thulium laser lithotripsy. The largest stone size was 2.35 ± 0.33 cm. Multiple stones were present in 8 (57.1%) patients. Obstructive jaundice was observed in 6 (42.9%) patients and cholangitis in 4 (28.6%). Results. The overall effectiveness of the method was 93%. Two sessions were required for 4 (28.6%) patients. The procedure duration was 88.5 ± 23.7 minutes. No complications were observed. Conclusion. Peroral cholangioscopy with thulium laser lithotripsy can be considered a method of choice for patients with bile duct stones >2 cm or multiple stones >1 cm. Further studies are required to improve the technique, clarify the indications for its use, and determine the clinical and economic effectiveness.