Cholangioscopy-Guided Laser Lithotripsy for Removal of Large Biliary Stentoliths: A Prospective Case Series (with Video).

BACKGROUND

Forgotten plastic biliary stents become encased in stone (stentoliths), creating a difficult extraction challenge. Conventional methods often fail, requiring surgical intervention. The aim was to describe cholangioscopy-guided laser lithotripsy for complete clearance of stentoliths.

METHODS

In this prospective case series, consecutive patients with forgotten biliary stents and large stentoliths, not removable by conventional methods were included between January 2022 and December 2024. All the included patients underwent cholangioscopy-guided laser lithotripsy. The technique involved circumferential laser fragmentation of the stone encasing the stent, followed by stent removal and complete clearance of stentolith.

RESULTS

Eight consecutive patients with forgotten biliary stents (median duration 9 (5-20) years) with large stentoliths were treated. Technical and clinical success was achieved in all 8 (100%) patients. Median stone size was 32 mm (26-42). The median procedure time was 54 min (45-70). Seven (87.5%) patients achieved complete clearance in single session. One (12.5%) patient developed mild post-endoscopic retrograde cholangiopancreatography pancreatitis. No perforations, bleeding, or mortality were observed. All the patients were asymptomatic with normalized liver biochemistry at 6-week follow-up.

CONCLUSIONS

Cholangioscopy-guided laser lithotripsy is safe and highly effective for forgotten stents with large stentoliths, offering a promising alternative to surgery in experienced centers.