Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

Gutierrez, Olaya I. Brewer; Bekkali, Noor; Raijman, Isaac; Sturgess, Richard; Sejpal, Divyesh V.; Aridi, Hanaa Dakour; Sherman, Stuart; Shah, Raj J.; Kwon, Richard S.; Buxbaum, James; Zulli, Claudio; Wassef, Wahid; Adler, Douglas G.; Kushnir, Vladimir; Wang, Andrew Y.; Krishnan, Kumar; Kaul, Vivek; Tzimas, Demetrios; DiMaio, Christopher J.; Ho, Sammy; Petersen, Bret T.; Lee, Moon Sung; Elmunzer, B. Joseph; Webster, George; Chen, Yen I.; Dwyer, Larry; Inamdar, Summant; Patrick, Vanessa; Attwell, Augustin; Hosmer, Amy; Ko, Christopher; Maurano, Attilio; Sarkar, Avik; Taylor, Linda J.; Gregory, Martin; Strand, Daniel S.; Raza, Ali; Kothari, Shivangi; Harris, J. Roger; Kumta, Nikhil A.; Manvar, Amar; Topazian, Mark D.; Lee, Yun Nah; Spiceland, Clayton M.; Trindade, Arvind J.; Bukhari, Majidah; Sanaei, Omid; Ngamruengphong, Saowanee; Khashab, Mouen A.

doi:10.1016/j.cgh.2017.10.017

Cited by 93 publications

(87 citation statements)

References 14 publications

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“…In the future, this high success rate will probably lead to the progressive adoption of these techniques for complex biliary stones. This apparent trend toward higher success rates in more recent reports [4, 12, 14] is likely to be related to cumulative experience with the technique combined with the introduction of the second generation of the SGDS system in 2012.…”

Section: Discussionmentioning

confidence: 87%

“…Several other studies have demonstrated successful management of difficult biliary stones using cholangioscopy-guided LL and EHL, with success rates ranging from 67 to 100% [2-5, 12]. In a large series that enrolled 69 patients with complex biliary stones treated with SGDS-guided HL, Patel et al [3] reported a successful extraction rate of 74% in the index ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…Probably we should opt for laser probes for very large or multiple stones to overcome this limitation of EHL probes. A recent multicenter study has addressed this issue assessing 406 patients [12]. This retrospective study compared outcomes between 306 patients submitted to EHL and 101 patients treated with HL.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports have suggested that cholangioscopy-guided LL is a safe and effective technique for the treatment of difficult biliary and pancreatic stones, although the experience with pancreatic stones is more limited [2-5, 11, 12]. There is no reported experience in Portugal with the second-generation digital cholangioscopy-guided lithotripsy system using EHL or HL.…”

Section: Introductionmentioning

confidence: 98%

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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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“…A retrospective study of 407 patients who underwent POC for difficult biliary stones at 22 tertiary centers in the USA, UK, or Korea showed 306 patients who underwent EHL and 101 (24.8%) who underwent laser lithotripsy . Mean procedure time was longer in the EHL group (73.9 min) than in the laser lithotripsy group (49.9 min; P < 0.001).…”

Section: Cholangioscopymentioning

confidence: 99%

Current endoscopic strategies for managing large bile duct stones

Doshi

Yasuda

Ryozawa

et al. 2018

Digestive Endoscopy

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Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.

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Intraductal Therapies

Nabi¹,

Reddy²

2020

Ercp

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Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

Cited by 93 publications

References 14 publications

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Current endoscopic strategies for managing large bile duct stones

Intraductal Therapies

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