Per-operative modified rigid cholangioscopy for removal of intrahepatic stones associated with choledochal cyst in children

Agrawal, Vikesh; Acharya, Himanshu; Saxena, Arjun; Sharma, Dhananjaya

doi:10.4103/jmas.jmas_83_18

Cited by 4 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While cholangioscopy includes additional cost of the cholangioscope, it has been found to be cost effective and cost saving in some analyses through avoidance of subsequent procedures through direct visualization and therapy in a single session or determination of the optimal path forward when immediate therapy is not possible (17). While cholangioscopy practice patterns and outcomes have been reported in the literature for adult patients, pediatric cholangioscopy remains relatively unstudied to date, with only case reports and small case series, which have attested to the clinical utility of cholangioscopy (11)(12)(13)(14). To the best of our knowledge, the present study represents the largest series of pediatric cholangioscopy procedures to date and the first to rigorously assess the rate at which cholangioscopy is performed in children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…Although cholangioscopy is now widely available through a variety of platforms and has an established role in endoscopic biliary diagnosis and therapy for adults, the utility of cholangioscopy and cholangioscopy‐guided interventions in pediatric practice are not well‐characterized by comparison. Reports of cholangioscopy to date have been limited to case reports and small case series (11–14) reflecting potential under‐utilization, or at the least less investigation surrounding, cholangioscopy in children relative to adults. Some factors which may limit utilization of cholangioscopy in children include patient size, pediatric endoscopist training and lower prevalence of pancreaticobiliary disorders considered amenable to cholangioscopic evaluation and/or therapy in children.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Cholangioscopy in Children and Adolescents: Utilization, Outcomes, and Safety

Barakat

Berquist

Gugig

2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly utilized for management of biliary disorders in children and adolescents. Practice patterns surrounding cholangioscopy in pediatric patients, however, are largely uncharacterized. Methods: We retrospectively analyzed all ERCPs in which cholangioscopy was performed on patients 18 and under at our tertiary care children’s hospital from 2015 to 2020 using our institution’s paper and electronic medical record system. Patient demographics, procedure indications, interventions, and associated adverse events were analyzed. Results: Over the study period, 307 ERCPs were performed on 282 patients at our children’s hospital. Cholangioscopy was performed in 36 procedures (11.7%) using the SpyGlass cholangioscope (Boston Scientific). Antibiotics to cover biliary organisms were administered to all patients precholangioscopy. Mean patient age was 13.6 years (range 7–18 years). The 2 most common indications for cholangioscopy included electrohydraulic lithotripsy for biliary stone disease and evaluation of biliary stricture (with incidental finding of biliary web in 2 patients and retained suture material in 2 patients). Adverse events were less prevalent in patients who underwent cholangioscopy relative to those who underwent ERCP. 0/36 (0%) developed post-ERCP pancreatitis, one patient had self-limited melena (possible self-limited postsphincterotomy bleeding). Patient care was enhanced by cholangioscopy in 30/36 (83.3%) of these patients. Conclusions: These data attest to the safety and clinical utility of cholangioscopy in children and adolescents. Cholangioscopy was performed in just over 11% of pediatric patients who underwent ERCP at our academic medical center—rates similar to those reported in adult patients. The radiation-sparing nature of cholangioscopy, coupled with these data supporting its safety, make it particularly appealing for use in children. Further multi-institution evaluation of the utility, safety, and range of indications for cholangioscopy in other practice settings would be of great interest and help guide endoscopic care.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Cholangioscopy in Children and Adolescents: Utilization, Outcomes, and Safety

Barakat

Berquist

Gugig

2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

show abstract

“…This combination of DSOC with ERCP was not associated with adverse maternal and fetal outcomes[ 122 ]. Case series have also reported successful choledochoscopy with no significant complications in children for indications such as intrahepatic lithotripsy[ 123 ], evaluation of biliary strictures, and management before and after liver transplant[ 124 ]. While choledochoscopy in children is beyond the scope of this review, it can be extrapolated to be a safe and effective modality used in pediatric biliary pathologies such as Caroli disease, biliary atresia, and monitoring post-Kasai procedure.…”

Section: Complicationsmentioning

confidence: 99%

Choledochoscopy: An update

Lee¹,

Teng²,

Shelat³

2021

WJGE

View full text Add to dashboard Cite

Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.

show abstract

“…Intraoperative cholangioscopy using a paediatric cystoscope has been described by Takahashi et al ., and Agrawal et al ., for irrigating and clearing IHBD debris, stones, and dilatation of stenosis during CC surgery which can reduce incidence of post-operative IHS. [ 41 42 43 ]…”

Section: Intrahepatic Stones In Choledochal Cyst: Seeing the Unseen?mentioning

confidence: 99%

Laparoscopic management of choledochal cyst in children

Liêm

Agrawal

Aison

2021

Journal of Minimal Access Surgery

Self Cite

View full text Add to dashboard Cite

Choledochal cyst (CC) is a disease with a strong Asian preponderance. As laparoscopic surgery has become mainstay in its treatment, the experience in these countries has been phenomenal. However, there are many contentious issues related with the laparoscopic management of CC. In this review article, we will try to answer the contentious questions related to the laparoscopic management of CC. The issues related to aetiology, classification, surgical technique, type of biliary anastomosis, intrahepatic stones and malignancy are discussed. We also discuss the current and future considerations of laparoscopic management with reference to it becoming a gold standard. This article describes the standard surgical approach and will discuss its technical nuances. This article will also discuss the outcome of treatment in different settings of low- and middle-income countries based on lessons learnt by the authors from their experience and research.

show abstract

Per-operative modified rigid cholangioscopy for removal of intrahepatic stones associated with choledochal cyst in children

Abstract: Per-operative rigid endoscopy using paediatric cystoscope is an easily available tool in most of the setups for the management of IHS associated with CDC in children.

Cited by 4 publications

References 15 publications

Cholangioscopy in Children and Adolescents: Utilization, Outcomes, and Safety

Cholangioscopy in Children and Adolescents: Utilization, Outcomes, and Safety

Choledochoscopy: An update

Laparoscopic management of choledochal cyst in children

Contact Info

Product

Resources

About