Intraductal lithotripsy

Abstract

Symptomatic bile duct stones and hepaticolithiasis has become a domain of endoscopic treatment. Intraductal lithotripsy comprises different techniques of stone destruction that are based on oral or percutaneous endoscopic access to the bile duct system. Mechanical lithotripsy is a readily available method; however, stone removal may fail with hard, impacted, or big bile duct stones. The primary advantage of cholangioscopy is the direct visualization of the biliary tree. Laser lithotripsy and electrohydraulic lithotripsy require cholangioscopy technique, as visualization of the stone is needed to guarantee effective destruction and to avoid damage to the bile duct wall. Stones can then be removed after fragmentation. In this chapter we discuss advantages and disadvantages of different intraductal lithotripsy techniques as well as tips and tricks for their successful clinical application.