ArticleCardiovascular and interventional radiology2026
Flexible Percutaneous Laser Lithotripsy for Intrahepatic Stones: A Multicenter Study in Western Patients.
Article in Cardiovascular and interventional radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
Authors and funding
12 authors.
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Abstract
introductionIntrahepatic lithiasis (IHL) remains a challenging condition in populations, particularly in patients with surgically altered biliary anatomy or failed endoscopic interventions. Percutaneous laser lithotripsy (PLL) under flexible cholangioscopic guidance has emerged as a minimally invasive alternative for managing complex intrahepatic stones. PURPOSE: To evaluate the efficacy and safety of flexible PLL for the treatment of intrahepatic stones in a multicenter Brazilian cohort with altered anatomy or failed ERCP. MATERIALS AND
methodsThe primary outcome was technical success, defined as complete ductal clearance confirmed by cholangioscopy or MRI at 1-month follow-up. Clinical success was defined as resolution of biliary symptoms without recurrence or need for additional intervention during follow-up. Secondary outcomes included the number of lithotripsy sessions, complication rates, and symptomatic stone recurrence.
resultsComplete ductal clearance was achieved in 100% of patients, with a mean of 1.29 lithotripsy sessions per patient. Minor complications occurred in 11.4% of cases, with no major adverse events, bile duct injuries, or procedure-related deaths. No symptomatic recurrence was observed during a mean follow-up of 14.7 months. Notably, five incidental biliary polyps were identified under direct cholangioscopic visualization; one was confirmed as low-grade dysplasia. These lesions were not detected on preprocedural imaging, highlighting the added diagnostic value of cholangioscopy.
conclusionFlexible PLL is a safe, effective, and reproducible technique for managing complex intrahepatic lithiasis, especially in patients with altered anatomy or failed endoscopic treatment. The added diagnostic yield and potential for outpatient protocols using disposable cholangioscopes support broader adoption of this approach in interventional radiology.
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