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Laser Versus Mechanical Lithotripsy of Bile Duct Stones

This study has been completed.
Information provided by (Responsible Party):
James Buxbaum, University of Southern California Identifier:
First received: December 31, 2012
Last updated: March 30, 2017
Last verified: March 2017

Very large bile duct stones are difficult to remove. The prefered method involves an endoscopic procedure known as endoscopic retrograde cholangiopancreatography (ERCP)performed using a special side viewing endoscope. In the past small baskets passed through the scope into the bile duct have been used to remove most stones using mechanical force.

Recently very small scopes known as cholangioscope have been introduced through the side viewing endoscope directly into the bile duct. These cholangioscopes may be used to guide laser therapy of bile duct stones. The investigators suspect that stone destruction using cholangioscopy guided laser stone destruction may enable bile duct stones to be removed more quickly and safely when added to the mechanical techniques.

Condition Intervention
Choledocholithiasis Procedure: Laser and mechanical lithotripsy Procedure: Mechanical Lithotripsy

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: Randomized Trial of Combination of Cholangioscopic Guided Laser Lithotripsy and Conventional Mechanical Versus Conventional Mechanical Methods for the Endoscopic Removal of Large Bile Duct Stones

Further study details as provided by James Buxbaum, University of Southern California:

Primary Outcome Measures:
  • Bile Duct Stone Clearance [ Time Frame: 12 months ]
    Confirmation that no further stones remain in the bile duct of the patient by cholangiography. Additionally, serum laboratory abnormalities in AST, ALT, Alkaline Phophatase, or bilirubin, or epigastric abdominal pain attributable to bile duct stones.

Secondary Outcome Measures:
  • Number of ERCP [ Time Frame: 12 months ]
    The number of ERCP procedures required from enrollment in study to complete clearance of bile duct stones.

  • Total Procedure Time [ Time Frame: 12 months ]
    The total time in minutes for all the ERCP procedures required for stone rumoval.

  • Estimated Procedure Cost [ Time Frame: 12 months ]
    The cost of patient management for bile duct stones based on the cost of the procedure, hospitalization, and associated costs of complications of cholangitis, pancreatitis, perforation, and bleeding.

  • Cholangitis [ Time Frame: 12 months ]
    Cholangitis after or between ERCP procedures will be defined as a presentation with epigastric abdominal pain, temperature greater than 38.5 Celsius accompanied by either laboratory abnormalities of the AST, ALT, Alkaline Phosphatase, or Bilirubin or abnormal imaging of the biliary tree on ultrasound,computed tomography scan, or magnetic resonance cholangiopancreatography.

  • Pancreatitis [ Time Frame: 12 months ]
    Pancreatitis following or between ERCP procedures will be defined as the onset of epigastric abdominal pain and either amylase or lipase greater than 3 times the upper limit of normal or findings on ultrasound, computed tomography scan, or magnetic resonance cholangiopancreatography suggestive of pancreatic inflammation.

  • Bleeding [ Time Frame: 12 months ]
    Bleeding attributable to stone therapy will be defined as a drop in hemoglobin by more than 1 gm/dl following or between ERCP procedures with no other cause identified on standard clinical evaluation.

Enrollment: 60
Study Start Date: January 2013
Study Completion Date: March 2016
Primary Completion Date: March 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Laser and mechanical lithotripsy
Bile duct stones with be treated with cholangioscopy guided laser therapy in addition to mechanical basket and balloon techniques.
Procedure: Laser and mechanical lithotripsy
Patients will undergo cholangioscopy guided laser treatment in addition to treatment with mechanical lithotripsy using basket and balloon techniques.
Other Names:
  • Spyglass cholangioscopy
  • Holmium laser lithotripsy
Active Comparator: Mechanical lithotripsy
Patients in the mechanical lithotripsy arm will undergo treatment only with basket and balloon for removal of large stones.
Procedure: Mechanical Lithotripsy
Patients in the mechanical lithotripsy arm will undergo treatment only with basket and balloons to facilitate stone removal but not laser lithotripsy.

  Show Detailed Description


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Bile duct stone >1cm demonstrated on ultrasound, computed tomography, or magnetic resonance imaging
  • Bile duct dilatation >1cm

Exclusion Criteria:

  • Biliary, gallbladder or pancreatic malignancy
  • Pregnant
  • Prior biliary diversion surgery
  • Under age 18
  • Unable to give informed consent
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01759979

United States, California
Los Angeles County Hospital
Los Angeles, California, United States, 90033
Sponsors and Collaborators
University of Southern California
Principal Investigator: James L Buxbaum, MD University of Southern California
  More Information

Responsible Party: James Buxbaum, Director of Endoscopy, Los Angeles County Hospital, University of Southern California Identifier: NCT01759979     History of Changes
Other Study ID Numbers: HS-11-00718
Study First Received: December 31, 2012
Last Updated: March 30, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by James Buxbaum, University of Southern California:
Cholelithiasis, Common Bile Duct

Additional relevant MeSH terms:
Common Bile Duct Diseases
Bile Duct Diseases
Biliary Tract Diseases
Digestive System Diseases
Cholelithiasis processed this record on September 25, 2017