Comparison of therapeutic effects of endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet laser and traditional mechanical lithotripsy in patients with common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FAN Xiao , QI Xiaoliang , ZHU Yiming , HUANG Mingzhe , LOU Xiaolou ,  XIA Yan

Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201999, P. R. China;

Corresponding?author：

XIA Yan, Email: 13761388807@163.com

Keywords：

common bile duct stones; frequency-doubled double pulse neodymium yttrium aluminium garnet laser lithotripsy; mechanical lithotripsy; therapeutic effect

DOI：

10.7507/1007-9424.201911043

Video：

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Objective To compare difference of therapeutic effects between endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet (FREDDY) laser and endoscopic traditional mechanical lithotripsy in treatment of common bile duct stones (CBDs).Methods The clinical data of 207 patients with CBDs treated with ERCP and lithotripsy in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2009 to March 2019 were analyzed retrospectively, of which 71 cases treated by FREDDY (FREDDY group) and 136 cases treated by mechanical lithotripsy (mechanical group). The success rate of stone removal, operation time, postoperative hospitalization time, hospitalization cost, consumables cost, and complications were compared between the two groups.Results There were no significant differences in the general condition and the preoperative clinical data between the two groups (P>0.05). There was no perioperative death in the two groups. There were no significant differences in terms of the postoperative routine laboratory biochemical indexes, consumables cost, hospitalization cost, and rates of the bleeding, postoperative pancreatitis, perforation and biliary tract infection between the two groups (P>0.05). Although the operation time of the FREDDY group was significantly longer than that of the mechanical group (P<0.05), the success rate of stone removal was significantly higher, the postoperative hospitalization time was shorter, the total complications rate and stone residual rate were significantly lower in the FREDDY group as compared with the mechanical group (P<0.05).Conclusion Endoscopic FREDDY laser lithotripsy has a better curative effect and less complications in treatment of large CBDs than mechanical lithotripsy, but operation time needs further to be improved.

Citation： FAN Xiao, QI Xiaoliang, ZHU Yiming, HUANG Mingzhe, LOU Xiaolou, XIA Yan. Comparison of therapeutic effects of endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet laser and traditional mechanical lithotripsy in patients with common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1112-1116. doi: 10.7507/1007-9424.201911043 Copy

1.	Wijarnpreecha K, Panjawatanan P, Manatsathit W, et al. Association between juxtapapillary duodenal diverticula and risk of choledocholithiasis: a systematic review and meta-analysis. J Gastrointest Surg, 2018, 22(12): 2167-2176.
2.	Zhang W, Wang BY, Du XY, et al. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol, 2019, 25(8): 1002-1011.
3.	Kou K, Liu X, Hu Y, et al. Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration. J Int Med Res, 2019, 47(2): 1052-1058.
4.	Ahn DW, Lee SH, Paik WH, et al. Effects of saline irrigation of the bile duct to reduce the rate of residual common bile duct stones: a multicenter, prospective, randomized study. Am J Gastroenterol, 2018, 113(4): 548-555.
5.	Moon SH. An approach to patients with symptomatic cholelithiasis based on drgree of probability for choledocholithiasis. Korean J Med, 2017, 92(2): 150-154.
6.	Jung GS, Kim YJ, Yun JH, et al. Percutaneous transcholecystic removal of common bile duct stones: case series in 114 patients. Radiology, 2019, 290(1): 238-243.
7.	Zhou J, Xiao R, Yang JR, et al. Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report. J Int Med Res, 2018, 46(11): 4806-4812.
8.	Kim YA, Kim GM, Chun P, et al. Management of pediatric patients presenting with acute abdomen accompanying dilatation of the common bile duct. Pediatr Gastroenterol Hepatol Nutr, 2018, 21(3): 203-208.
9.	Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7): 1004-1021.
10.	Arya N, Nelles SE, Haber GB, et al. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol, 2004, 99(12): 2330-2334.
11.	Schreiber F, Gurakuqi GC, Trauner M. Endoscopic intracorporeal laser lithotripsy of difficult common bile duct stones with a stone-recognition pulsed dye laser system. Gastrointest Endosc, 1995, 42(5): 416-419.
12.	Ragheb S, Choong CK, Gowland S, et al. Extracorporeal shock wave lithotripsy for difficult common bile duct stones: initial New Zealand experience. N Z Med J, 2000, 113(1117): 377-378.
13.	Lei J, Wang J, Li Q, et al. Laparoscopic transcystic common bile duct exploration: T-shaped incision of cystic duct with FREDDY laser lithotripsy. J Laparoendosc Adv Surg Tech A, 2016, 26(8): 646-651.
14.	Kim TH, Oh HJ, Choi CS, et al. Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd: YAG laser. World J Gastroenterol, 2008, 14(18): 2863-2866.
15.	Hochberger J, Maiss J, Tex S, et al. First clinical data on Laserlithotripsy of common bile duct stones with a new frequency-doubled double-pulse ND: YAG-laser (FREDDY) in 19 patients. Gastrointest Endosc, 2001, 53(5): AB87.
16.	Liu F, Jin ZD, Zou DW, et al. Efficacy and safety of endoscopic biliary lithotripsy using FREDDY laser with a radiopaque mark under fluoroscopic guidance. Endoscopy, 2011, 43(10): 918-921.
17.	Yang T, Ma Z, Xu B, et al. Clinical role of frequency-doubled double-pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration. ANZ J Surg, 2019, 89(9): E358-E362.

1. Wijarnpreecha K, Panjawatanan P, Manatsathit W, et al. Association between juxtapapillary duodenal diverticula and risk of choledocholithiasis: a systematic review and meta-analysis. J Gastrointest Surg, 2018, 22(12): 2167-2176.
2. Zhang W, Wang BY, Du XY, et al. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol, 2019, 25(8): 1002-1011.
3. Kou K, Liu X, Hu Y, et al. Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration. J Int Med Res, 2019, 47(2): 1052-1058.
4. Ahn DW, Lee SH, Paik WH, et al. Effects of saline irrigation of the bile duct to reduce the rate of residual common bile duct stones: a multicenter, prospective, randomized study. Am J Gastroenterol, 2018, 113(4): 548-555.
5. Moon SH. An approach to patients with symptomatic cholelithiasis based on drgree of probability for choledocholithiasis. Korean J Med, 2017, 92(2): 150-154.
6. Jung GS, Kim YJ, Yun JH, et al. Percutaneous transcholecystic removal of common bile duct stones: case series in 114 patients. Radiology, 2019, 290(1): 238-243.
7. Zhou J, Xiao R, Yang JR, et al. Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report. J Int Med Res, 2018, 46(11): 4806-4812.
8. Kim YA, Kim GM, Chun P, et al. Management of pediatric patients presenting with acute abdomen accompanying dilatation of the common bile duct. Pediatr Gastroenterol Hepatol Nutr, 2018, 21(3): 203-208.
9. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7): 1004-1021.
10. Arya N, Nelles SE, Haber GB, et al. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol, 2004, 99(12): 2330-2334.
11. Schreiber F, Gurakuqi GC, Trauner M. Endoscopic intracorporeal laser lithotripsy of difficult common bile duct stones with a stone-recognition pulsed dye laser system. Gastrointest Endosc, 1995, 42(5): 416-419.
12. Ragheb S, Choong CK, Gowland S, et al. Extracorporeal shock wave lithotripsy for difficult common bile duct stones: initial New Zealand experience. N Z Med J, 2000, 113(1117): 377-378.
13. Lei J, Wang J, Li Q, et al. Laparoscopic transcystic common bile duct exploration: T-shaped incision of cystic duct with FREDDY laser lithotripsy. J Laparoendosc Adv Surg Tech A, 2016, 26(8): 646-651.
14. Kim TH, Oh HJ, Choi CS, et al. Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd: YAG laser. World J Gastroenterol, 2008, 14(18): 2863-2866.
15. Hochberger J, Maiss J, Tex S, et al. First clinical data on Laserlithotripsy of common bile duct stones with a new frequency-doubled double-pulse ND: YAG-laser (FREDDY) in 19 patients. Gastrointest Endosc, 2001, 53(5): AB87.
16. Liu F, Jin ZD, Zou DW, et al. Efficacy and safety of endoscopic biliary lithotripsy using FREDDY laser with a radiopaque mark under fluoroscopic guidance. Endoscopy, 2011, 43(10): 918-921.
17. Yang T, Ma Z, Xu B, et al. Clinical role of frequency-doubled double-pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration. ANZ J Surg, 2019, 89(9): E358-E362.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of therapeutic effects of endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet laser and traditional mechanical lithotripsy in patients with common bile duct stones

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