The Safety and Efficacy of Single-Operator Cholangioscopy in the Treatment of Difficult Common Bile Duct Stones after Failed Conventional ERCP

Sandha, Jaskiran; Zanten, Sander Veldhuyzen van; Sandha, Gurpal

doi:10.1093/jcag/gwy021

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…Patients requiring LABEL group appeared to have more complex gallstone pathology when compared with those who did not require LABEL, with more ductal calculi (2 [1-3] vs 1 [0-3], p = 0.007), greater size of the largest stone (10 [7-15] vs 5 [4][5][6][7] mm, p = 0.0001) and larger CBD diameter (12 [10][11][12][13][14][15] [1][2][3] days, p = 0.022).…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the use of EHL has recently gained popularity due to the fact that it utilises high-voltage electric sparks, rather than laser radiation, and hence requires less specialised theatre equipment [8]. Its use has mainly been limited to ERCP, however, partly due to the success of laser lithotripsy as a surgical technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…Strömberg et al suggested that stones exceeding 5 mm in size have a much lower likelihood of TC extraction and are susceptible to impaction [9]. As such, a variety of methods have been reported for improving extraction rate via the TC route including robotic techniques [10], micropercutaneous nephrolithotomy [11], electrohydraulic lithotripsy (EHL) [8,12] and, more recently, holmium laser lithotripsy [13]. The use of holmium laser treatment is already well established in urological surgery, including its use in ureteric stones, enucleation of the prostate, strictures and bladder tumours [14].…”

Section: Introductionmentioning

confidence: 99%

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Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Jones

Musawi

Navaratne

et al. 2019

Langenbecks Arch Surg

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Purpose Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy. Methods Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction. Results One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III-IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively. Conclusions LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Jones

Musawi

Navaratne

et al. 2019

Langenbecks Arch Surg

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“…Choledochoscopy may reduce the need to perform costlier procedures. In a study by Sandha et al [ 131 ] across 51 patients with difficult-to-access choledocholithiasis, choledochoscopy-guided lithotripsy circumvented the need for laparoscopic and open surgical bile duct exploration. This decreased costs per procedure by $1619 and $3210 respectively[ 131 ].…”

Section: Limitationsmentioning

confidence: 99%

Choledochoscopy: An update

Lee¹,

Teng²,

Shelat³

2021

WJGE

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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.

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“…[1] Today, as well as cholecystectomy+endoscopic retrograde cholangiopancreatography (LC+ERCP), conventional common bile duct exploration (CCBDE) (Choledochotomy+T-tube) and laparoscopic common bile duct exploration (LCBDE) can all be used in the treatment of CBD stones. [2] LCBDE is now a far more common approach, as laparoscopic techniques become more common and morbidity rates drop due to advances in technology and treatment outcomes are seen to be equal or better. [3] However, in the treatment of CBD stones, ERCP is still the most preferred treatment method although related complications such as pancreatitis, hemorrhage and duodenum perforation as well as the possibility of causing permanent sphincter malfunction lead to high morbidity rates.…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Laparoscopic And Conventional Technique In The Surgical Treatment Of Choledocholithiasis

Aydın¹

2020

Laparosc Endosc Surg Sci

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Introduction:The aim of the study is to compare f conventional and laparoscopic techniques in common bile duct exploration in terms of efficacy and safety. Materials and Methods:The data of 280 patients who underwent surgical procedure for common bile duct stones between January 2011 and December 2016 were retrospectively analyzed. This was an Ethics Committee-approved retrospective analysis of data between 2011 and 2016. The patients were divided into two groups according to the common bile duct exploration technique: laparoscopic (Group 1, 164 patients) and conventional (Group 2, 116 patients). The two groups were compared in terms of surgical findings and short-term results.Results: 170 (60.7%) of the patients were women. The mean age was 61.9±16.9 years. Clinical results showed that the operative time (120±35.9 vs 169±48.4 minutes, p<0.01) and hospital stay (6.3±3.9 vs 10.9±6.8 days, p<0.01) were shorter in Group 1; overall morbidity (9% vs 24%, p<0.01) and mortality rates (1.2% vs 6%, p<0.03) were lower. Postoperative endoscopic sphincterotomy requirement was less (7% vs 18.1%, p <0.01). In addition, in Group 1, there was a higher rate of stone clearance (93.9% vs 82.8%, p<0.01) with a lower rate of wound infection (0.6% vs 10.3%, p<0.01). No difference was observed in terms of re-operation, bile leakage or drain dislocation. Conclusion:In terms of stone clearance, hospital stay, morbidity, mortality and complication rates, laparoscopic common bile duct exploration is a significantly safer and more effective method compared to conventional exploration.

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The Safety and Efficacy of Single-Operator Cholangioscopy in the Treatment of Difficult Common Bile Duct Stones after Failed Conventional ERCP

Cited by 5 publications

References 16 publications

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Choledochoscopy: An update

Comparison Between Laparoscopic And Conventional Technique In The Surgical Treatment Of Choledocholithiasis

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