Electrohydraulic Lithotripsy in 111 Patients: A Safe and Effective Therapy for Difficult Bile Duct Stones

Arya, Naveen; Nelles, Sandra; Haber, Gregory B.; Kim, Young–In; Kortan, P

doi:10.1111/j.1572-0241.2004.40251.x

Cited by 166 publications

(98 citation statements)

References 18 publications

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“…Potential diagnostic applications include: the evaluation of J Gastrointestin Liver Dis, June 2017 Vol. 26 No 2: 165-170 indeterminate strictures in patients with or without primary sclerosing cholangitis (PSC), study of undetermined filling defects in bile ducts seen in MRCP or ERCP imaging, biopsy of lesions after nondiagnostic ERCP, preoperative precise location and extension of bile intraductal tumors, visual evaluation and biopsy to evaluate post-transplant biliary stenosis, diagnosis of intraductal mucinous neoplasms, assessment for cytomegalovirus, fungal and parasitic infections, and study of patients with hemobilia [5,6]. As a therapeutic tool, cholangioscopy can be used to treat biliary stones that have failed extraction with conventional ERCP techniques, can be an alternative to surgery in patients with type II Mirizzi syndrome, allows placement of stents in the cystic duct, photodynamic therapy of cholangiocarcinoma and photocoagulation with argon in cases of intraductal mucinous neoplasia [5,6].…”

Section: Introductionmentioning

confidence: 99%

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

Pereira

Peixoto

Andrade

et al. 2017

JGLD

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Smaller endoscopes and catheters have been developed that permit direct visualization of the bile and pancreatic ducts (cholangioscopy and pancreatoscopy, respectively). These endoscopes and catheters are passed through the working channel of a standard therapeutic duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). The SpyGlass Direct Visualization System (Boston Scientific Corp, Natick, MA, USA) is currently the most widely used and studied device. Cholangioscopy with intraductal lithotripsy has become an established modality in the treatment of difficult biliary lithiasis. When used in the evaluation of indeterminate biliary strictures by experienced endoscopists in recognizing intraductal pathology, it increases the diagnostic yield of tissue sampling. Pancreatoscopy is complementary to other imaging modalities in the evaluation of intraductal papillary mucinous neoplasms of the pancreas and is emerging as a sole or adjunctive therapy to extracorporeal shock wave lithotripsy for the treatment of main pancreatic duct stones. It remains investigational in the diagnosis of pancreatic adenocarcinoma. Complications specific to the performance of cholangiopancreatoscopy include cholangitis, which is related to intraductal fluid irrigation.Abbreviations: EHL: Electrohydraulic lithotripsy; ERCP: Endoscopic retrograde cholangiopancreatography; ESWL: Extracorporeal lithotripsy by shock waves; ET: Endoscopic therapy; EUS: Endoscopic ultrasound; IPMN: intraductal papillary mucinous neoplasm; LL: Laser lithotripsy; MDCT: Multi-detector computed conventional tomography; MPD: Main pancreatic duct; MRCP: Magnetic resonance cholangiopancreatography; MRI: Magnetic resonance imaging; POCPS: Peroral cholangiopancreatoscopy; PSC: Primary sclerosing cholangitis

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Section: Introductionmentioning

confidence: 99%

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

Pereira

Peixoto

Andrade

et al. 2017

JGLD

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“…Intracorporeal lithotripsy must be used under direct visual control with an additional endoscope, to ensure safety and precise targeting during stone fragmentation. POC with intracorporeal lithotripsy achieves complete clearance of difficult extrahepatic biliary stones in 83-100% of patients [8,9], demonstrating an important therapeutic application of single-operator POC [10]. The successful treatment of CBD stones by EHL under transnasal direct cholangioscopy has been reported in one case [11].…”

Section: Endoscopic Lithotripsy For Difficult Bile Duct Stones Under mentioning

confidence: 97%

Therapeutic role of direct peroral cholangioscopy using an ultra‐slim upper endoscope

Lee¹,

Ko²

2010

J Hepato Biliary Pancreat

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Introduction Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother–baby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra‐slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra‐slim endoscope for therapeutic application in patients with biliary diseases. Methods Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra‐slim upper endoscope with a larger, 2‐mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories. Conclusion Direct POC with an ultra‐slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.

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“…In intraoperative choledochoscopy, the stones or stone particles can be directly seen, as well as the stones are easily differantiated from blood cougulum or air bubbles [3,11]. Additionally, electrohidrolic or laser lithotripsy can be performed by this technique [3,18,[21][22][23][24][25][26][27]. On the other hand, some other major application areas of choledochoscopy are biopsy or cytology for the diagnosis of biliary tract malignencies, intrabiliary rupture of hydatid cysts, balloon dilatation of the biliary tract, electrocoagulation, or stent application for biliary malignencies [3,6,7,11,12,14,16,17,26,[28][29][30][31][32][33], similar to our study.…”

Section: Discussionmentioning

confidence: 99%

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

et al. 2016

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Objective: Advances in choledochoscopy technology lead to an improvement in the diagnosis and treatment of hepatopancreatobiliary diseases. The aim of this study is to reveal the role of choledochoscopy in hepatopancreatobiliary pathologies. Materials and Methods:Choledochoscopy was used under general anesthesia in operation rooms. Flexible choledochoscope inserted via a vertical choledochotomy line, which was closed by primary closure, T-tube application, or choledochoduodenal anastomosis. Olympus CHF T 20 flexible choledochoscope and related endoscopic instruments were used for the procedures. The records were evaluated retrospectively. Results:This study presents the findings of 235 intraoperative choledochoscopy procedures. The most common indications were suspected common bile duct stone in 96 patients (40.9%), serum cholestatic enzyme increase without jaundice in 52 (22.1%), obstructive jaundice and/or serum bilirubin increase in 46 (19.6%), and presence of dilated choledoch in 42 (17.9%). Additional endoscopic diagnostic and/or therapeutic procedures were performed 156 times in 125 patients (53.2%), and endoscopic biliary stone removal was the most used procedure (87 patients, 37.0%). The mean choledochoscopy duration was 8.5 minutes (range: 5-25 minutes). Choledochoscopy confirmed preliminary diagnosis in 117 patients (49.8%), while different data were elicited in 68 (28.9%), and normal findings were found in 50 (21.3%). In this series, no choledochoscopy-related mortality was seen, and some complications occurred in 4 patients (1.7%). Conclusion:Intraoperative flexible choledochoscopy is a proper technique in the diagnosis and treatment of hepatopancreatobiliary disorders. Bulgular: Bu çalışmada 235 intraoperatif koledokoskopi işlemi sonuçları sunulmaktadır. En sık endikasyonlar 96 hastada (%40,9) koledok taşı şüphesi, 52'sinde (%22,1) sarılık olmaksızın serum kolestaz enzim yüksekliği, 46'sında (%19,6) tıkanma sarılığı ve/ veya serum bilirübin yüksekliği ve 42'sinde (%17,9) de geniş koledok varlığıydı. Ek endoskopik tanısal ve/veya terapötik işlemler 125 hastada (%53,2) 156 kez uygulandı ve safra taşı çıkarılması en sık kullanılan işlemdi (87 hasta, %37,0). Ortalama koledokoskopi süresi 8,5 dakikaydı (5-25 dakika arasında). Koledokoskopi 117 hastada (%49,8) ilk tanıyı doğrularken 68'inde (%28,9) farklı bulgular verdi, 50'sinde (%21,3) ise normal bulgular elde edildi. Bu seride koledokoskopi ile ilişkili ölüm görülmedi, 4 hastada (%1,7) bazı komplikasyonlar gelişti.Sonuç: İntraoperatif fleksibl koledokoskopi, hepatopankreatobiliyer hastalıkların tanı ve tedavisinde yararlı bir tekniktir.

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Electrohydraulic Lithotripsy in 111 Patients: A Safe and Effective Therapy for Difficult Bile Duct Stones

Cited by 166 publications

References 18 publications

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

Therapeutic role of direct peroral cholangioscopy using an ultra‐slim upper endoscope

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

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