Peroral cholangioscopic treatment of hepatolithiasis: Long-term results

Okugawa, Tadahiro; Tsuyuguchi, Toshio; C, Sudhamshu K.; Ando, Takeshi; Ishihara, Takeshi; Yamaguchi, Taketo; Yugi, Hirokazu; Saisho, Hiromitsu

doi:10.1016/s0016-5107(02)70040-0

Cited by 75 publications

(25 citation statements)

References 19 publications

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“…This demonstrates that the optimal non-operative management option remains to be defined. Currently, there are many East Asian centres in Taiwan, Japan, and Korea with a high incidence of RPC, developing various methods of peroral or percutaneous cholangioscopic treatment modalities with encouraging results [9, 10, 19, 20]. Those methods have also become the main non-operative treatment modalities in preference to cholangiography guided options.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence

et al. 2013

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Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both; nonoperative options include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) guided procedures. This current study compares the operative and the nonoperative management outcomes in patients with RPC in 80 consecutive patients. In addition, we aim to evaluate our approach to the management of RPC over the past decade, according to the various degrees of severity and extent of the disease, and identify the patterns of recurrence in this complex clinical condition. Initial failure rate in terms of residual stone of operative compared with nonoperative treatment was 10.2% versus 32.3% (P = 0.020). Long-term failure rate for operative compared with non-operative treatment was 20.4% versus 61.3% (P = 0.010). Based on multivariate logistic regression, the only significant factors associated with failure were bilaterality of disease (OR: 8.101, P = 0.007) and nonoperative treatment (OR: 26.843, P = 0.001). The median time to failure of the operative group was 48 months as compared to 20 months in the nonoperative group (P < 0.010). Thus operative treatment is a durable option in long-term resolution of disease. Hepatectomy is the preferred option to prevent recurrent disease. However, biliary drainage procedures are also an effective treatment option. The utility of nonoperative treatment can achieve a reasonable duration of disease free interval with minimal complications, albeit inferior to operative management.

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Section: Discussionmentioning

confidence: 99%

Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence

et al. 2013

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“…Continuous irrigation of the CBD is required and whilst stone recognition systems have been developed which allow laser therapy to be performed under fluoroscopic guidance193 194 treatment generally involves direct visualisation of the stone using a choledochocope. Compared to the other forms of lithotripsy described the numbers treated to date using these techniques are small.…”

Section: 0 Management Of “Difficult” Stone Diseasementioning

confidence: 99%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

507

374

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The last 30 years have seen major developments in the management of gallstone-related disease, which in the United States alone costs over 6 billion dollars per annum to treat. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widely available and routine procedure, whilst open cholecystectomy has largely been replaced by a laparoscopic approach, which may or may not include laparoscopic exploration of the common bile duct (LCBDE). In addition, new imaging techniques such as magnetic resonance cholangiography (MR) and endoscopic ultrasound (EUS) offer the opportunity to accurately visualise the biliary system without instrumentation of the ducts. As a consequence clinicians are now faced with a number of potentially valid options for managing patients with suspected CBDS. It is with this in mind that the following guidelines have been written.

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“…Nonoperative treatments offer attractive alternatives, particularly for patients with mild extensive form of hepatolithiasis, for older patients with prohibitive operative risk, and for those with multiple previous operations. [6] Surgery remains the main treatment option for hepatolithiasis with the main aim to completely remove the stones, remedy for strictures, free drainage, prevent recurrent hepatolithiasis, restore the biliary tract to normal physiological function, and cure disease. [7] …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis

Feng²,

Yang³

et al. 2017

Medicine

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To investigate the clinical significance of hepatic parenchyma incision by lithotomy near the second hepatic portal area for the treatment of complex hepatolithiasis.A retrospective study was conducted with 35 patients who had complicated hepatolithiasis in our hospital from January 2008 to December 2013, who underwent hepatic parenchyma incision by lithotomy near the second hepatic portal area. The perioperative and long-term outcomes included the stone clearance rate, operative morbidity and mortality, and the stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded from the study.All patients with hepatic duct stones were mainly located at S2, S4, and S8 regions. Surgical methods included were hepatic parenchyma incision by lithotomy near the second hepatic portal area, or by combined partial hepatectomy. The mean follow-up period was 51 months. One patient died during hospitalization. The surgical morbidity was 17.6%, stone clearance rate was 88.2%, and final clearance rate was 94.1% followed by postoperative choledochoscopic lithotripsy. The stone recurrence rate was 15.6% and the occurrence of postoperative cholangitis was 11.8% during the follow-up period.Hepatic parenchyma incision by lithotomy near the second hepatic portal area is safe with satisfactory short and long-term outcome results for complicated hepatolithiasis.

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Peroral cholangioscopic treatment of hepatolithiasis: Long-term results

Cited by 75 publications

References 19 publications

Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence

Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence

Guidelines on the management of common bile duct stones (CBDS)

Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis

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