Electrohydraulic Lithotripsy and Laser Lithotripsy

Mechanical lithotripsy is usually employed for the fragmentation of large common bile duct (CBD) stones. However, refractory CBD stones, stones larger than 2 cm in size, those firmly impacted, those located above a bile duct stricture, and those located in the intrahepatic bile duct, or cases of Mirizzi syndrome are difficult to treat. Recently, electrohydraulic lithotripsy (EHL) or laser lithotripsy has been indicated for the foregoing cases. EHL and laser lithotripsy are usually performed under cholangioscopic guidance with irrigation inside the CBD in order to clearly visualize the lumen and remove debris. The stone clearance rates of EHL and laser lithotripsy range from 74% to 95% and from 88% to 97%, respectively. Most complications related to EHL or laser therapy are associated with endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage, such as pancreatitis, hemorrhage, perforation, and sepsis. The overall complication rate of EHL or laser lithotripsy was reported to be 7–9%, including hemobilia and cholangitis. Perforation of the bile duct due to EHL or laser lithotripsy is rare. Further refinements of the EHL instruments, laser lithotripsy instruments, and cholangioscope are required for improving the ease of use of EHL and laser lithotripsy.