Electrohydraulic Lithotripsy for Difficult Bile Duct Stones under Endoscopic Retrograde Cholangiopancreatography and Peroral Transluminal Cholangioscopy Guidance

Abstract

Background/AimsElectrohydraulic lithotripsy (EHL) under endoscopic retrograde cholangiopancreatography (ERCP) guidance can be an option to treat difficult stones. Recently, a digital, single-operator cholangioscope (SPY-DS) has become available. Peroral transluminal cholangioscopy (PTLC) using SPY-DS has also been reported. In this retrospective study, the technical feasibility and clinical effectiveness of EHL for difficult bile duct stones under ERCP guidance and under PTLC guidance was examined.MethodsIn this pilot study, patients with difficult bile duct stones between July 2016 and July 2017 were retrospectively enrolled.ResultsForty-two consecutive patients underwent EHL using a SPY-DS; 34 patients underwent EHL under ERCP guidance, and the other 8 patients underwent EHL under PTLC guidance. Median procedure time was 31 minutes (range, 19 to 66 minutes). The median number of EHL sessions was 1 (range, 1 to 2), and that of ERCP sessions was also 1 (range, 1 to 3). The rate of complete stone clearance was 98% (41/42). Adverse events such as cholangitis and acute pancreatitis were seen in 14% (6/42), which could be treated conservatively.ConclusionsEHL using SPY-DS was technically feasible, not only under ERCP guidance, but also PTLC guidance. A prospective clinical study of EHL using SPY-DS is needed.

Single‐operator peroral cholangioscope in treating difficult biliary stones: A systematic review and meta‐analysis

“…Median diameter was 14.5 mm (range: 10–30 mm) and 18.7 mm (range: 4–60 mm), respectively. Fourteen studies reported stone location . Apart from the two studies discussing cystic duct stones, the predominant location of DBDS was the common bile duct (proportion ranged from 57.6% to 100%) in the other studies, where location data were available.…”

“…Baseline characteristics of the studies are presented in Table . Fourteen studies reported procedure duration . Median duration was 68.7 min, ranging from 30 min to 165 min.…”

“…Median duration was 68.7 min, ranging from 30 min to 165 min. Two studies reported interval between SOPOC insertion and removal (range: 10–66 min) . Six studies had detailed follow‐up information .…”

“…Figure 1 shows the PRISMA flow diagram of selected studies. Of the 24 studies evaluated, 13 were carried out in America, 12,14,15,[17][18][19]21,22,25,26,30,31,35 seven in Asia, 13,20,23,24,27,29,34 three in Europe, 16,28,33 and one was a multinational study spanning America, Asia, and Europe. 32 Ten studies were multicenter.…”

“…12,14,16,19,22,23,25,30,32,33 Two studies were randomized controlled trials (RCT), 26,35 and the remaining 22 were cohort studies. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33][34] Seven of the cohort studies were prospective, [13][14][15]23,[27][28][29] and the remaining 15 were retrospective. 12,[16][17][18][19][20][21][22]24,25,…”