Methods, Indications, and Results of Percutaneous Choledochoscopy

Ponchon, Thierry; Génin, G.; Mitchell, Richard; Henry, Luc; Bory, R; Bodnar, Dominique; Valette, Pierre-Jean

doi:10.1097/00000658-199601000-00005

Cited by 59 publications

(52 citation statements)

References 33 publications

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“…; this dilation often required a few days to several weeks [1,8,10,13,14]. The procedure was subsequently delayed 1-6 weeks to allow tract maturation prior to performing PTCS [1,8,10,13,14]. We have experienced high therapeutic success and minimal morbidity performing PTCS via tracts created and dilated on the same day.…”

mentioning

confidence: 99%

Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease

1999

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Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease

1999

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“…In spite of the surgeons remarkable efforts, the residual biliary stone incidence is still high [9,10]. On the other hand, not only the biliary stones, but also papilla tumors and stenosis, choledoch tumors, cysts and parasites, liver tumors and cysts, and pancreas tumors and cycts, which are the major hepatopancreatobiliary patologies, make the choledochoscopy important [10][11][12].…”

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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“…Patients must be closely followed during this time to recognize these complications as early as possible. Failure to extract retained stones most commonly occurs secondary to tortuosity of the T-tube tract or dislodgement of the T tube with obliteration of the tract lumen preventing reintubation [2, 3]. …”

Section: Discussionmentioning

confidence: 99%

“…1b). The diameter of the sheath (allowing free play of the T tube) is determined by the size of the extraction instruments to be used according to local resources and routines (angiographic versus percutaneous cholangioscopy) [2, 3]. …”

Section: Case Reportsmentioning

confidence: 99%

“…Common bile duct (CBD) calculi are found in 8–15% of all cholecystectomy patients while retained CBD stones occur in up to 4% of patients, accounting for approximately 5,000 cases of CBD calculi per year in the United States [1, 2, 3]. The optimal treatment of CBD stones is controversial, and depends on local expertise, the patient’s medical condition and the time of diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Management of T Tubes for Common Bile Duct Stones: A New Technique

Stein

Sclafani²,

Kral³

1998

Dig Surg

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Background: The optimal treatment of common bile duct (CBD) stones is controversial, and depends on local expertise, the patient’s medical condition and the time of diagnosis. Current practice entails a wide variation in the duration of leaving T tubes in place, anywhere from 7 to 30 days, and in the time to postoperative cholangiogram. Here we present a new technique for T-tube placement and management of secondary or retained CBD calculi that reduces T-tube duration to ≤ 5 days. Materials and Methods: After CBD exploration and clearance, we place a 10- to 18-French T tube through a 22- to 34-French straight rubber catheter with side holes acting as a sheath. The two tubes are exteriorized together, with the sheath protruding 1–2 cm. We place a colostomy bag for collecting possible abdominal drainage over the site and run the T tube through the colostomy bag into a bile bag. Results: Our method allows early removal of the T tube in patients with cleared ducts and early radiologic instrumentation of the CBD through the sheath to extract retained calculi. This obviates the need for postoperative endoscopic retrograde cholangiopancreaticography. Conclusion: This method reduces the length of hospital stay, the number of outpatient office visits and postoperative studies, and the duration of T-tube drainage, potentially decreasing the incidence of complications of T tubes, improving patient satisfaction.

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Methods, Indications, and Results of Percutaneous Choledochoscopy

Abstract: Percutaneous choledochoscopy can be used routinely, provided that strict techniques are adhered to. This procedure should be reserved for only a small subset of biliary diseases.

Cited by 59 publications

References 33 publications

Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease

Experience with percutaneous transhepatic cholangioscopy (PTCS) in the management of biliary tract disease

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

Management of T Tubes for Common Bile Duct Stones: A New Technique

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