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Treatment for Biliary Stone by Peroral Cholangioscopy (PCS) Yasuyuki Fujita 1 , Rikiya Fujita 2 , Nobuto Hirata 2 , Fumio Sugata 2 1Fujita Clinic 2Department of Gastroenterology, Showa University Fujigaoka Hospital pp.747-754
Published Date 1989/7/25
DOI https://doi.org/10.11477/mf.1403106500
  • Abstract
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 The aim of this paper is to clarify the usefulness of PCS in therapy of cases with biliary stone.

 The instruments which we have employed in this study are the latest model mother scope TJFM-20 and baby scope CHFB-20 manufactured by Olympus optical company. The most advanced improvement of this model is that the baby scope is equipped with a bigger channel diameter of 1.7 mm. This bigger channel is large enough to accomodate available basket catheter, biopsy and grasping forceps, the electrode for electrohydraulic shock wave lithotripsy (EHL), and quartz fiber for Nd: YAG laser lithotripsy. An angulation system extends the range of visual field and facilitates selective insertion into the biliary duct system. Such improvements have brought about great advances in therapeutic capabilities.

 In the therapeutic field, PCS has two roles. One is to examine whether sludges and/or fragmented stones remain after lithotripsy by conventional methods, and the other is to smash the large such as the lumen-filling stone, which can't be smashed even by mechanical lithotripsy, by EHL or laser lithotripsy under visualization.

 In the former role, stone removal with basket catheter was successfully carried out in 5 cases. Of these, gallbladder stones were extracted by peroral cholecystoscopy in one case.

 In the latter role, EHL was attempted in three cases with common bile duct stones and one intrahepatic stone. Laser lithotripsy was attempted for two cases with common bile duct stones. These lithotripsy techniques were successfully carried out in all cases.

 In comparison with laser lithotripsy, EHL is a more practicable and easier technique from the following view points, namely, powerful lithotripsy effect, thin and flexible probe and a low cost.

 From our clinical experiences, we concluded as follows; (1) therapeutic approaches for biliary stone utilizing PCS are clinically becoming much more practicable, and (2) EHL is much superior to laser lithotripsy in transduodenal lithotripsy.


Copyright © 1989, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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