Abstract
The pulsed dye laser is safe and effective in lithotripsy of biliary and pancreatic
ductal stones, however delivery of the laser energy to the site of the calculi is
technically difficult. A 3.4 mm miniscope inserted through a standard duodenoscope
was used for transpapillary laser application under direct vision in one patient with
an impacted pancreatic stone and in three patients with bile duct stones not amenable
to treatment by routine endoscopy. Lithotripsy and ductal clearance was achieved in
3 of the 4 patients within a single treatment session. Percutaneous transhepatic laser
lithotripsy via a 3.7 mm miniscope succeeded in the patient in whom the peroral approach
had failed and in two further patients with bile duct stones not accessible by a retrograde
approach. There were no major complications. The miniscopes provide an appropriate
direct visual control for laser lithotripsy of pancreatobiliary calculi. This approach
using miniscopes seems to be an effective, minimally invasive and time-saving alternative
to conventional endoscopic laser lithotripsy.
