Cholangioscopy-guided electrohydraulic lithotripsy versus laser lithotripsy for the treatment of choledocholithiasis: a systematic review

Figures & data

Figure 1. PRISMA flow diagram of article selection.

Table 1. Description of studies utilizing per-oral cholangioscopy-guided lithotripsy.

Reference, year	Study design	Lithotripsy modalities included	Number of Patients^a	Complete bile duct clearance	Stone size (mm)	Number of sessions for complete bile duct clearance
Leung et al. (1989) [18]	Prospective	EHL (Lithotron); Mother-baby with fluoroscopy	5	100%	31 – largest	3
Cotton et al. (1990) [6]	Prospective	LL (Candela); Percutaneous/Minifiberscope/Mother-baby/Fluoroscopy	17	80% of total	18	NR
Ponchon et al. (1991) [22]	Prospective	LL (Pulsolith); T-tube/Percutaneous/Fluoroscopy	14	36%	22	NR
Neuhaus et al. (13993) [7]	Prospective	LL(Candela/Alexandrite); Percutaneous/Mother-baby	12	83.3%	20 – largest	NR
Prat et al. (1994) [8]	Prospective	LL (Candela); Mother-baby/Gastroscope^b/Trans-hepatic	13	84.6%	NR	2.7 of total
Adamek et al. (19395) [19]	Randomized trial	EHL (Lithotron); Mother-baby vs. ESWL	17	76.5%	21.3	1.4
Jakobs et al. (19936) [9]	Prospective	LL with tissue stone detection system (Rhodomine 6 G); Fluoroscopy +/− Mother-baby	30	80%	18	NR
Adamek et al. (13996) [20]	Prospective	EHL (Lithotron); Mother-baby; ESWL	46	74%	24.3	1.1
Neuhaus et al. (1998) [10]	Randomized trial	LL with tissue stone detection system (Rhodomine 6 G); Mother-baby +/−Fluoroscopy vs. ESWL	30	97%	24.2	1.2
Panpimanmas et al. (2000) [11]	Prospective	LL with tissue stone detection system (Rhodomine 6 G); Mother-baby/Fluoroscopy	21	90.5%	25	NR
Hui et al. (2003) [21]	Prospective	EHL (Lithotron); Mother-baby; Stent	17	76.5%	30	5.5
Kim et al. (2011) [23]	Prospective	LL (Holmium); Ultraslim endoscope	13	84.6%	20.9	1.4
Maydeo et al. (2011) [25]	Prospective	LL (Holmium); Single-operator peroral cholangioscope for biliary and pancreatic duct stones	60	100%	23.4	1.2
Wong et al. (2017) [26]	Prospective	LL (Holmium); Single-operator peroral cholangioscope	17	94%	20	1
Buxbaum et al. (2018) [27]	Randomized trial	LL (Holmium); Single-operator peroral cholangioscope vs. Conventional therapy	42	92.9%	19	1.9
Canena et al. (2019) [31]	Prospective	LL (Holmium) and EHL (Autolith); Single-operator peroral cholangioscope for biliary and pancreatic duct stones	10 LL + 4 EHL	100%	17	1
Angsuwatcharakon et al. (2019) [28]	Randomized trial	LL (Holmium); Single-operator peroral cholangioscope vs. Mechanical lithotripsy	16	100%	19.5	1
Maydeo et al. (2019) [32]	Prospective	LL and EHL; Single-operator peroral cholangioscope	117 LL + 39 EHL	87.2%	18 – largest	1.1
Bang et al. (2020) [29]	Randomized trial	LL (Holmium); Single-operator peroral cholangioscope vs. Large balloon sphincteroplasty	33	93.9%	15	1
Goenka et al. (2021) [24]	Prospective	LL (Holmium); Single-operator peroral cholangioscope	67	91%	20.4	1.4
Li et al. (2021) [30]	Randomized trial	LL (U100plus); Single-operator peroral cholangioscope vs. Laparoscopic common bile duct exploration	78	92.3%	25.3 – largest	NR

EHL: electrohydraulic lithotripsy; LL: laser lithotripsy; NR: not reported; ESWL: Extracorporeal shock-wave lithotripsy.

^aPOC-guided patients.

^bGastroscope through a choledochoduodenal anastomosis.

Figure 2. Forest plot depicting the odds ratios of lithotripsy modalities on bile duct stone clearance and adverse events.

Leung JW, Chung SS. Electrohydraulic lithotripsy with peroral choledochoscopy. BMJ. 1989;299(6699):595–598.

 PubMed Web of Science ®Google Scholar

Cotton PB, Kozarek RA, Schapiro RH, et al. Endoscopic laser lithotripsy of large bile duct stones. Gastroenterology. 1990;99(4):1128–1133.

 PubMed Web of Science ®Google Scholar

Ponchon T, Gagnon P, Valette PJ, et al. Pulsed dye laser lithotripsy of bile duct stones. Gastroenterology. 1991;100(6):1730–1736.

 PubMed Web of Science ®Google Scholar

Neuhaus H, Hoffmann W, Zillinger C, et al. Laser lithotripsy of difficult bile duct stones under direct visual control. Gut. 1993;34(3):415–421.

 PubMed Web of Science ®Google Scholar

Prat F, Fritsch J, Choury AD, et al. Laser lithotripsy of difficult biliary stones. Gastrointest Endosc. 1994;40(3):290–295.

 PubMed Web of Science ®Google Scholar

Adamek HE, Buttmann A, Wessbecher R, et al. Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones. A prospective randomized trial. Dig Dis Sci. 1995;40(6):1185–1192.

 PubMed Web of Science ®Google Scholar

Jakobs R, Maier M, Kohler B, et al. Peroral laser lithotripsy of difficult intrahepatic and extrahepatic bile duct stones: laser effectiveness using an automatic stone-tissue discrimination system. Am J Gastroenterol. 1996;91(3):468–473.

 PubMed Web of Science ®Google Scholar

Adamek HE, Maier M, Jakobs R, et al. Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy. Gastrointest Endosc. 1996;44(1):40–47.

 PubMed Web of Science ®Google Scholar

Neuhaus H, Zillinger C, Born P, et al. Randomized study of intracorporeal laser lithotripsy versus extracorporeal shock-wave lithotripsy for difficult bile duct stones. Gastrointest Endosc. 1998;47(5):327–334.

 PubMed Web of Science ®Google Scholar

Panpimanmas S, Chantawibul S, Ratanachu-Ek T. Pulse dye laser lithotripsy for large biliary tract stones. J Med Assoc Thai. 2000;83:433–438.

 PubMedGoogle Scholar

Hui CK, Lai KC, Ng M, et al. Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Aliment Pharmacol Ther. 2003;17(2):289–296.

 PubMed Web of Science ®Google Scholar

Kim HI, Moon JH, Choi HJ, et al. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones (with video). Gastrointest Endosc. 2011;74(5):1127–1132.

 PubMed Web of Science ®Google Scholar

Maydeo A, Kwek BE, Bhandari S, et al. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). Gastrointest Endosc. 2011;74(6):1308–1314.

 PubMed Web of Science ®Google Scholar

Wong JC, Tang RS, Teoh AY, et al. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones. Endosc Int Open. 2017;5(1):E54–e58.

 PubMedGoogle Scholar

Buxbaum J, Sahakian A, Ko C, et al. Randomized trial of cholangioscopy-guided laser lithotripsy versus conventional therapy for large bile duct stones (with videos). Gastrointest Endosc. 2018;87(4):1050–1060.

 PubMed Web of Science ®Google Scholar

Canena J, Lopes L, Fernandes J, et al. Outcomes of single-operator cholangioscopy-guided lithotripsy in patients with difficult biliary and pancreatic stones. GE Port J Gastroenterol. 2019;26(2):105–113.

 PubMedGoogle Scholar

Angsuwatcharakon P, Kulpatcharapong S, Ridtitid W, et al. Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study. Endoscopy. 2019;51(11):1066–1073.

 PubMed Web of Science ®Google Scholar

Maydeo AP, Rerknimitr R, Lau JY, et al. Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates. Endoscopy. 2019;51(10):922–929.

 PubMed Web of Science ®Google Scholar

Bang JY, Sutton B, Navaneethan U, et al. Efficacy of single-operator cholangioscopy-guided lithotripsy compared with large balloon sphincteroplasty in management of difficult bile duct stones in a randomized trial. Clin Gastroenterol Hepatol. 2020;18(10):2349–2356.e3.

 PubMed Web of Science ®Google Scholar

Goenka MK, Shah BB, Rodge GA, et al. Efficacy and safety of cholangioscopy guided laser lithotripsy for difficult bile duct stones – A prospective study from a tertiary care centre in Eastern India. Arab J Gastroenterol. 2021;22(2):111–114.

 PubMed Web of Science ®Google Scholar

Li G, Pang Q, Zhai H, et al. SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial. Surg Endosc. 2021;35(7):3723–3731.

 PubMed Web of Science ®Google Scholar