Innovations in Intraductal Endoscopy

Shah, Raj J.

doi:10.1016/j.giec.2015.06.012

Cited by 29 publications

(10 citation statements)

References 55 publications

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“…Intraductal lithotripsy under direct visualization can be achieved by either electrohydraulic therapy (EHL) or laser lithotripsy (LL). The EHL probe consists of two coaxially insulated electrodes attached to a generator producing high voltage electrical impulses at a frequency of 1 to 20 Hz, with power settings between 50%-100%[15]. Sparks at this site produce high amplitude hydraulic pressure waves during water immersion, which help in stone fragmentation[16].…”

Section: Resultsmentioning

confidence: 99%

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Kaura

Willingham

Chawla

2019

WJGE

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BACKGROUNDPer-oral pancreatoscopy (POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIMTo evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODSTo determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid. Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound (IDUS) and POP combined with image-enhancing technology.RESULTSThe success rate for complete ductal stone clearance ranged from 37.5%-100%. Factors associated with failure included the presence of strictures, multiple stones and the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy, and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSIONCurrent evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.

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Section: Resultsmentioning

confidence: 99%

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Kaura

Willingham

Chawla

2019

WJGE

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“…However, there are also a few disadvantages compared with the other current video mother-baby type POCPS [8][9][10] or direct POCPS [11][12][13][14][15][16] systems as the video mother-baby type POCPS system still has a better image quality than the SpyDS; the direct POCPS system has a 2.0-mm accessory channel enabling several interventions that can be performed using 5-Fr diagnostic and therapeutic devices (e.g. photodynamic therapy devices, argon plasma coagulation probe).…”

Section: Discussionmentioning

confidence: 99%

New digital cholangiopancreatoscopy for diagnosis and therapy of pancreaticobiliary diseases (with videos)

Tanaka

Itoi

Honjo

et al. 2016

J Hepato Biliary Pancreat

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“…Laser lithotripsy and electrohydraulic lithotripsy (EHL) via cholangioscopy facilitate access to the intrahepatic calculi and provide a simple and effective way to disintegrate large or cast-shaped calculi or relieve impaction under direct visualization. 55 Holmium laser and EHL achieve a high success rate of up to 90% final stone clearance, alongside low complication rates. 56 We used EHL at 70~90 V, and holmium laser technology with energy levels set at 800 mJ, 15 Hz and 16 W. 57 , 58 The tip of the EHL fibre should protrude about 2–3 mm from the scope and be positioned en-face with the calculus.…”

Section: Complicated Calculi Management By Pocmentioning

confidence: 98%

Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy

Wen

Wang

Huang

et al. 2017

Therap Adv Gastroenterol

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Hepatolithiasis is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. The ultimate goal of hepatolithiasis treatment is the complete removal of the stone, the correction of the associated strictures and the prevention of recurrent cholangitis. Although hepatectomy could effectively achieve the above goals, it can be restricted by the risk of insufficient residual liver volume, and has a 15.6% rate of residual hepatolithiasis. With improvements in minimally invasive surgery, post-operative cholangioscopy (POC), provides an additional option for hepatolithiasis treatment with higher clearance rate and fewer severe complications. POC is very safe, and can be performed repeatedly until full patient benefit is achieved. During POC three main steps are accomplished: first, the analysis of the residual hepatolithiasis distribution indirectly by imaging methods or directly endoscopic observation; second, the establishment of the surgical pathway to relieve the strictures; and third, the removal of the stone by a combination of different techniques such as simple basket extraction, mechanical fragmentation, electrohydraulic lithotripsy or laser lithotripsy, among others. In summary, a step-by-step strategy of POC should be put forward to standardize the procedures, especially when dealing with complicated residual hepatolithiasis. This review briefly summarizes the classification, management and complications of hepatolithiasis during the POC process.

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Innovations in Intraductal Endoscopy

Cited by 29 publications

References 55 publications

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Role of pancreatoscopy in management of pancreatic disease: A systematic review

New digital cholangiopancreatoscopy for diagnosis and therapy of pancreaticobiliary diseases (with videos)

Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy

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