Treatment of biliary calculi using holmium: Yttrium aluminum garnet laser

Background: The holmium: yttrium aluminum garnet laser (Ho: YAG) has been shown to be effective and safe for the treatment of urinary calculi. Its effectiveness for the treatment of biliary calculi was investigated. Methods: Endoscopic Ho: YAG lithotripsy of biliary stones was performed 7 times in 4 patients. Two patients had biliary duct calculi, and the other two patients had gall bladder calculi. All patients had multiple calculi that ranged in size from 4 mm to 5 cm. All procedures were performed percutaneously under intravenous sedation and local anesthesia. Rigid and flexible endoscopes were used to access the biliary calculi. Postoperative cholangiograms were performed on all patients. Results: All calculi were successfully fragmented with the Ho: YAG laser. The most common settings on the laser were 1.0 J and 10 Hz. Average total laser energy used was 12.24 kJ. Two patients required multiple procedures for the resolution of the biliary calculi. No vascular or biliary injuries were encountered. Three patients were free of biliary calculi on their postoperative cholangiogram. One patient with multiple gallbladder stones refused further treatment after two percutaneous procedures. Conclusion: The holmium:yttrium aluminum garnet laser can be used safely and effectively in the endoscopic treatment of biliary calculi. This treatment maybe a suitable option in patients who are not candidates for more invasive procedures.