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Wongkanong C, Ratanachu-Ek T, Patumanond J. Comparative Success Rate and Adverse Effects of Endoscopic Sphincterotomy Versus Endoscopic Papillary Large Balloon Dilation in Large Common Bile Duct Stones Removal. A Propensity Scores Inverse Weighting Analysis. J Gastroenterol Hepatol 2025; 40:510-519. [PMID: 39567773 DOI: 10.1111/jgh.16825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/01/2024] [Accepted: 11/07/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND/AIMS Endoscopic sphincterotomy (EST) is a standard treatment for common bile duct (CBD) stones. Endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation (EST-EPLBD) is an effective treatment for difficult CBD stones. This study aims to evaluate and compare the effectiveness and adverse effects of EST-EPLBD and EST in treating large CBD stones. METHODS We retrospectively analyzed the data of 85 patients with large CBD stones who underwent either EST or EST-EPLBD, resulting in successful CBD stone extraction from January 2018 to June 2022. Propensity score inverse weighting was performed to reduce the possible bias in baseline characteristics between the two treatment groups. The success rate of complete stone removal in the first session, mechanical lithotripsy use, and adverse events were analyzed by multivariable risk regression analysis. RESULTS The rate of complete stone removal in one session of the EST-EPLBD group was higher than that of the EST group at 28.78% (95% confidence interval [CI] 4.43, 50.1; p = 0.003). Mechanical lithotripsy use was decreased in the EST-EPLBD group by 25.81% (95% CI 42.33,9.28; p = 0.002). However, the incidence of adverse events is comparable. CONCLUSION EST-EPLBD may be utilized in the treatment of CBD stones that exceed a diameter of 10 mm. The EST-EPLBD increased the rate of complete stone removal in a single session and reduced the need for mechanical lithotripsy. Conversely, the incidence rate of adverse events is similar.
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Affiliation(s)
| | - Thawee Ratanachu-Ek
- Surgical Endoscopy Unit, Department of Surgery Rajavithi Hospital, Department of Medical Services, Ministry of Public Health, Nonthaburi, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology & Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
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Sayeed MS, Sharma S, Rajput JPS, Shah D, Saiyad SS, Saiyad T, Shah N, Kumar R C. Therapeutic Endoscopic Interventions in Choledocholithiasis: Efficacy of Endoscopic Retrograde Cholangiopancreatography. Cureus 2025; 17:e76955. [PMID: 39906449 PMCID: PMC11793112 DOI: 10.7759/cureus.76955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 02/06/2025] Open
Abstract
INTRODUCTION Choledocholithiasis, a condition characterized by stones in the common bile duct (CBD), frequently results in obstructive jaundice and associated complications. Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as the gold standard for treating this condition, offering a minimally invasive therapeutic approach. However, while ERCP is widely used, its efficacy in managing diverse clinical presentations and potential complications necessitates further investigation. Additionally, data on ERCP's effectiveness in various clinical scenarios, particularly concerning stone size and location, remain inconsistent, highlighting the need for more comprehensive research in this area. OBJECTIVE This study aims to evaluate the effectiveness of ERCP as a therapeutic intervention for choledocholithiasis, focusing on procedural outcomes, stone clearance rates, and associated complications. METHODS A retrospective study was conducted on 50 patients diagnosed with choledocholithiasis who underwent ERCP at a tertiary care hospital between January 2022 and December 2023. Data on patient demographics, clinical presentation, imaging, laboratory findings, and procedural outcomes were collected. ERCP procedures, including endoscopic sphincterotomy (ES) with balloon extraction and stenting, were performed by experienced endoscopists. Statistical analysis was done using SPSS version 25. RESULTS The majority of patients were aged 31-70 years, with abdominal pain (96%) being the most common symptom. ERCP successfully cleared the CBD in 76% of cases in a single session, with repeat ERCP required for 18% of patients. Complications occurred in 20% of cases, with pancreatitis (10%) being the most common. Smaller stones (≤10 mm) had higher success rates for single-session clearance, while larger stones (>15 mm) often required repeat procedures or surgery. Distal CBD stones were cleared more effectively compared to those in proximal locations. CONCLUSION ERCP remains an effective and safe treatment for choledocholithiasis, particularly for smaller and distal CBD stones. The procedure's safety and efficacy support its continued use as the gold standard for managing choledocholithiasis.
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Affiliation(s)
| | | | | | - Dhvani Shah
- Pediatric Surgery, B.J. Medical College and Civil Hospital, Ahmedabad, IND
| | | | - Tehsin Saiyad
- Microbiology, Veer Narmad South Gujarat University, Surat, IND
| | - Nehal Shah
- Pharmacology, Dr. M.K. Shah Medical College and Research Centre, Ahmedabad, IND
| | - Chetan Kumar R
- Forensic Medicine, Rajmata Vijaya Raje Scindia Medical College, Bhilwara, IND
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Manti M, Shah J, Papaefthymiou A, Facciorusso A, Ramai D, Tziatzios G, Papadopoulos V, Paraskeva K, Papanikolaou IS, Triantafyllou K, Arvanitakis M, Archibugi L, Vanella G, Hollenbach M, Gkolfakis P. Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:340. [PMID: 38399627 PMCID: PMC10890215 DOI: 10.3390/medicina60020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10-15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.
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Affiliation(s)
- Magdalini Manti
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Jimil Shah
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Apostolis Papaefthymiou
- Endoscopy Unit, Cleveland Clinic London, London SW1X 7HY, UK;
- Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Georgios Tziatzios
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Vasilios Papadopoulos
- Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Konstantina Paraskeva
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (I.S.P.); (K.T.)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (I.S.P.); (K.T.)
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium;
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.A.); (G.V.)
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.A.); (G.V.)
| | - Marcus Hollenbach
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, D-04103 Leipzig, Germany;
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium;
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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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Jimenez MC, Cubas RF, Bowles RJ, Martinez JM. Type IV Mirizzi Syndrome: Brief Report and Review of Management Options. Am Surg 2023; 89:2030-2036. [PMID: 35623343 DOI: 10.1177/00031348221105182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mirizzi syndrome is a rare complication of chronic calculous cholecystitis. Preoperative diagnosis is challenging due to the absence of pathognomonic signs and symptoms and low sensitivity rates of imaging tests. Historically, laparotomy has been the preferred choice of surgical management. Endoscopic and laparoscopic approaches have been increasingly described as diagnostic and therapeutic options for Mirizzi type I and II, but data is limited regarding the management of more complex cases. We describe a staged endoscopic and laparoscopic approach for the management of type IV Mirizzi syndrome and review the management options.
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Affiliation(s)
- M Carolina Jimenez
- Department of Surgery, Division of Laparoendoscopic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Robert F Cubas
- Department of Surgery, Division of Laparoendoscopic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - R Joshua Bowles
- Department of Surgery, Division of Laparoendoscopic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Jose M Martinez
- Department of Surgery, Division of Laparoendoscopic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
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Chuang TW, Leung J, Chen JJ, Lee PL, Tung HD, Fang ML, Ou-Yang MC, Chen JL. Bile Duct Stone Size May Influence the Efficacy of Endoscopic Sphincterotomy With or Without Large-Balloon Dilation: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 33:355-369. [PMID: 36576861 DOI: 10.1089/lap.2022.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Endoscopic sphincterotomy (EPT) combined with endoscopic papillary large balloon dilatation (EPBD) are used to remove large common bile duct (CBD) stones. This meta-analysis compared the efficacy and safety of EPT+EPBD versus EPT alone in the removal of stones based on stone size. Materials and Methods: Twenty-two studies (11 randomized control trials [RCTs] and 11 non-RCTs) were identified and reviewed based on searches of Embase, PubMed, and Web of Science. CBD stone's size was measured with reference to diameter of the duodenoscope (13 mm) and size of the large dilatation balloon (17 mm) seen on cholangiogram. The stone clearance rate, required mechanical lithotripsy (ML), procedure time, and pancreatitis were compared according to the mean stone size, and further divided into Groups A (small) 10-13 mm, B (medium) 13-17 mm, and C (large) >17 mm. Results: Subgroup analysis according to CBD stone size showed EPT + EPBD had a significantly better initial stone clearance rate than EPT in Groups B (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.20-4.77) and C (OR = 3.05, 95% CI: 1.86-5.03), but not for Group A (OR = 1.41, 95% CI: 0.90-2.21). EPT+EPBD also required significantly less ML than EPT in Groups B (OR = 0.34, 95% CI: 0.15-0.77) and C (OR = 0.31, 95% CI: 0.13-0.73). EPT+EPBD had significantly shorter procedure time than EPT in Group B (standardized mean difference = -1.20, 95% CI: -2.08 to 0.32). In meta-regression analysis, Group B had a better OR in initial stone clearance rate and less ML usage rate correlation with the size of CBD stone, but not for Group C with larger stones. Conclusions: EPT+EPBD had a significantly better initial stone clearance rate, and required less ML with shorter procedure time than EPT for removing medium-sized CBD stones, but the efficacy was limited to large CBD stones. The study protocol and trial registration had been registered in PROSPERO (Registration No. CRD42020171689).
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Affiliation(s)
- Tang-Wei Chuang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Joseph Leung
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and UC Davis Medical Center, Sacramento, California, USA
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hung-Da Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Min-Lin Fang
- Medicine Library and Center for Knowledge Management, University of California, San Francisco, California, USA
| | - Mei-Chen Ou-Yang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Jyu-Lin Chen
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Aziz M, Khan Z, Haghbin H, Kamal F, Sharma S, Lee-Smith W, Pervez A, Alastal Y, Nawras A, Thosani N. Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis. Endosc Int Open 2022; 10:E1599-E1607. [PMID: 36531684 PMCID: PMC9754880 DOI: 10.1055/a-1958-2348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/04/2022] [Indexed: 10/17/2022] Open
Abstract
Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques. Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis. Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00-1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31-0.74) and EPLBD (RR: 0.58, CI: 0.34-0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs). Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
| | - Zubair Khan
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, Texas
| | - Hossein Haghbin
- Division of Gastroenterology, Ascension providence Hospital, Southfield, Michigan, United States
| | - Faisal Kamal
- Division of Gastroenterology, University of California, San Francisco, California, United States
| | - Sachit Sharma
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, United States
| | - Asad Pervez
- Division of Gastroenterology, West Virginia University, Morgantown, West Virginia, United States
| | - Yaseen Alastal
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, Texas
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Singla V, Arora A, Bopanna S, Khare S, Kumar A, Bansal N, Sharma P. Outcome of Digital Cholangioscopy and Laser Lithotripsy for Impacted Biliary Stones. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Background and Aims Impacted stones in the bile duct are difficult to extract, and are predictor of failure of conventional endoscopic retrograde cholangiopancreatography techniques including mechanical lithotripsy and large balloon dilatation. Intracorporeal lithotripsy may be an effective technique for these stones. The aim of this study is to report the efficacy and safety of intracorporeal laser lithotripsy for impacted stones in the bile duct.
Method This study is retrospective analysis of prospectively collected data. Patients with impacted stones in the bile duct underwent cholangioscopy with spyglass DS system and laser lithotripsy. Outcome measures were proportion of patients with complete clearance of bile duct after the first session, number of sessions required for complete clearance, and the complications.
Results Forty-three patients (27 female) with mean age of 56.12 ± 15.16 years underwent digital cholangioscopy and laser lithotripsy. Mean bilirubin value was 1.8 ± 1.6 mg/dL, 20 (46.51%) patients had single stone, 35(81.39%) patients had only bile duct stones, and 8(18.61%) patients had additional stones in cystic duct or intrahepatic biliary radical. Mean size of largest stone was 16.2 ± 4.4mm. Average duration of the procedure was 69.11 ± 28.12minutes, and complete clearance was achieved in 41/43 (95.34%) patients after the first session. Mean number of sessions required for complete clearance was 1.02 ± .26. Postprocedure cholangitis occurred in one patient.
Conclusion Intracorporeal laser lithotripsy is an effective and safe modality for the clearance of impacted bile duct stones.
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Affiliation(s)
- Vikas Singla
- Center for Gastroenterology, Hepatology and Endoscopy, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Sawan Bopanna
- Center for Gastroenterology, Hepatology and Endoscopy, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Shivam Khare
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Mony S, Ghandour B, Raijman I, Manvar A, Ho S, Trindade AJ, Benias PC, Zulli C, Jacques J, Ichkhanian Y, Zuchelli T, Ghanimeh MA, Irani S, Canakis A, Sanaei O, Szvarca D, Zhang L, Bejjani M, Akshintala V, Khashab MA. An international experience with single-operator cholangiopancreatoscopy in patients with altered anatomy. Endosc Int Open 2022; 10:E898-E904. [PMID: 35692911 PMCID: PMC9187392 DOI: 10.1055/a-1794-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and study aims The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. Technical success was defined as completing the intended procedure with the use of D-SOCP. Results Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail.
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Affiliation(s)
- Shruti Mony
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Isaac Raijman
- Greater Houston Gastroenterology, Houston, Texas, United States
| | - Amar Manvar
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Sammy Ho
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Arvind J. Trindade
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Petros C. Benias
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Claudio Zulli
- Division of Gastroenterology and Hepatology, Hospital of Salerno, G. Fucito Center, Mercato San Severino, Italy
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Limoges Dupuytren Hospital, Lyon, France
| | - Yervant Ichkhanian
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | - Tobias Zuchelli
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | | | - Shayan Irani
- Digestive Disease Institute at Virginia Mason Medical Center, Seattle, Washington, United States
| | - Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Daniel Szvarca
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Vaccari S, Minghetti M, Lauro A, Bellini MI, Ussia A, Khouzam S, Marino IR, Cervellera M, D'Andrea V, Tonini V. Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures? Dig Dis Sci 2022; 67:1116-1127. [PMID: 35318553 DOI: 10.1007/s10620-022-07450-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
Biliary lithiasis is common worldwide, affecting almost 20% of the general population, though few experience symptoms. The frequency of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be 10-33%, depending on patients' age. Unlike gallbladder lithiasis, the medical and surgical treatment of common bile duct stones is uncertain, having changed over the last few years. The prior gold standard treatment for cholelithiasis and choledocholithiasis was open cholecystectomy with bile duct clearance, choledochotomy, and/or surgical sphincterotomy. In the last 10-15 years, new treatment approaches to the complex pathology of choledocholithiasis have emerged with the advent of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic surgery, and advanced diagnostic procedures. Although ERCP followed by laparoscopic cholecystectomy is the preferred mode of management, a single-step strategy (laparo-endoscopic rendezvous) has gained acceptance due to lesser morbidity and a lower risk of iatrogenic damage. Given the above, a tailored approach relying on careful evaluation of the disease is necessary in order to minimize complication risks and overall costs. Yet, the debate remains open, with no consensus on the superiority of laparo-endoscopic rendezvous to more conventional approaches.
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Affiliation(s)
- S Vaccari
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - M Minghetti
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Department of Surgical Sciences, Sapienza University, Rome, Italy.
| | - M I Bellini
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - A Ussia
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - S Khouzam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Department of General Surgery, Ospedale Santissima Annunziata, Taranto, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - V Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
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11
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Cheng C, Tang K, Cheng S, Fang H, Shiue S, Suk F, Lien G, Wu M. Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chao‐Ling Cheng
- Graduate Institute of Clinical Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Kung‐Pei Tang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Sheng‐Wei Cheng
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Hua‐Chen Fang
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Sheng‐Jie Shiue
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Fat‐Moon Suk
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Gi‐Shih Lien
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Ming‐Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Integrative Therapy Center for Gastroenterologic Cancers, Wan Fang Hospital Taipei Medical University Taipei Taiwan
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12
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Is the use of fully covered metal stents effective in the treatment of difficult lithiasis of the common bile duct? Surg Endosc 2022; 36:5684-5691. [PMID: 34993589 DOI: 10.1007/s00464-021-08919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/21/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND The management of difficult lithiasis of common bile duct (CBD) often requires a multimodal approach. Fully Covered Metal Stents (FCSEMS) could fragment the stones, dilate strictures of the CBD and progressively enlarge the papillary orifice. The aim of the study was to evaluate the efficacy of FCSEMS in the treatment of difficult lithiasis of CBD. METHODS All consecutive cases of difficult lithiasis of CBD after an attempt of clearance with complete sphincterotomy were retrospectively considered from 2009 to 2019. Intrahepatic lithiasis cases were excluded. Multivariable analysis (stepwise logistic regression if p value < 0.1 at univariable analysis) was made to understand factors associated with efficacy of FCSEMS in difficult lithiasis of CBD. RESULTS 163 cases of difficult lithiasis over 1516 cases of lithiasis of CBD (incidence of 11%) were considered. Among eligible patients, 96 (mean age 78 ± 11.9 years, 43% males) placed a FCSEMS during the first ERCP. Mean diameter of stone was 17.5 ± 5.5 mm. An attempt of dilation during the same procedure was made in 18% cases. After removal of the stent, 52 (54%) patients had complete clearance of CBD at cholangiography. The rest of patients (44), subsequently underwent multimodal treatment (final success of 95%). After logistic regression, variables positively associated with clearance of CBD were sex male (OR 3.5) and stent permanence ≥ 30 days (OR 3.2). Diameter of the stone ≥ 2 cm was associated with failure (OR 0.2). 7 post-ERCP pancreatitis, 6 post-sphincterotomy bleeding and 3 cholangitis occurred. CONCLUSIONS FCSEMS are useful in the approach of difficult lithiasis of CBD with no significant adverse events associated.
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13
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Lee T, Teng TZJ, Shelat VG. Choledochoscopy: An update. World J Gastrointest Endosc 2021; 13:571-592. [PMID: 35070020 PMCID: PMC8716986 DOI: 10.4253/wjge.v13.i12.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- Tsinrong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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14
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Guzmán-Calderón E, Martinez-Moreno B, Casellas JA, Aparicio JR. Per-oral pancreatoscopy-guided lithotripsy for the endoscopic management of pancreatolithiasis: A systematic review and meta-analysis. J Dig Dis 2021; 22:572-581. [PMID: 34436824 DOI: 10.1111/1751-2980.13041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/30/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pancreatic stones result from chronic pancreatitis and can occur in the main pancreatic duct, pancreatic branches or parenchyma. Although extracorporeal shock wave lithotripsy (ESWL) is considered the first-line treatment, per-oral pancreatoscopy (POP) has emerged as a useful method for treating pancreatic stones. The aim of this systematic review and meta-analysis was to determine the efficacy and safety of POP-guided lithotripsy, electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL), in patients with pancreatolithiasis. METHODS Literature review was conducted in PubMed, OVID, MEDLINE and Cochrane Library databases for studies published up to August 2020. RESULTS Altogether 15 studies were analyzed, of which 11 were retrospective and four were prospective. The studies comprised 370 patients, of whom 66.4% were male. The patients underwent 218 EHL and 155 LL. The pooled technical and clinical success rate of the overall POP was 88.1% and 87.1%. For EHL-POP, the pooled technical success rate was 90.9% (95% CI 87.2%-95.2%) and the pooled clinical success rate was 89.8% (95% CI 87.2%-95.2%). While for LL-POP, the pooled technical and clinical success rate was 88.4% (95% CI 85.9%-95.1%) and 85.8% (95% CI 80.6%-91.6%). In total 43 adverse events occurred (12.1%; 95% CI 8.7%-15.5%). CONCLUSION POP-guided lithotripsy has a high rate of technical and clinical success for managing pancreatolithiasis with a low complication rate. Both EHL-POP and LL-POP achieve similar efficacy in the endoscopic therapy of pancreatolithiasis. Further large randomized controlled trials are needed to compare EHL-POP and LL-POP with ESWL and evaluate whether POP may replace ESWL as the first-line management of pancreatolithiasis.
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Affiliation(s)
- Edson Guzmán-Calderón
- Gastroenterology Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Gastroenterology Unit, Angloamericana Clinic, Lima, Peru
| | | | - Juan A Casellas
- Gastroenterology Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - José Ramón Aparicio
- Gastroenterology Unit, Hospital General Universitario de Alicante, Alicante, Spain
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15
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Ierardi AM, Rodà GM, Di Meglio L, Pellegrino G, Cantù P, Dondossola D, Rossi G, Carrafiello G. Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones. J Clin Med 2021; 10:1372. [PMID: 33805334 PMCID: PMC8037114 DOI: 10.3390/jcm10071372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. METHODS We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DSTM for visualization and an EH system for lithotripsy. RESULTS Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered. CONCLUSION PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondation IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
| | - Giovanni Maria Rodà
- Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy; (G.M.R.); (L.D.M.); (G.P.)
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy; (G.M.R.); (L.D.M.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduation School in Radiodiagnostics, University of Milan, via Festa del Perdono, 20122 Milan, Italy; (G.M.R.); (L.D.M.); (G.P.)
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondation IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan Via F. Sforza 35, 20122 Milan, Italy;
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondation IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.D.); (G.R.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondation IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.D.); (G.R.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondation IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
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16
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Antypas P, Cereatti F, Fiocca F, Cappello A, Eberspacher C, Fanello G, Mascagni D, Donatelli G. Difficult biliary stones in the elderly: Endoscopic retrograde cholangiography - A single surgical tertiary centre experience with follow-up. J Minim Access Surg 2021; 17:502-508. [PMID: 33605927 PMCID: PMC8486058 DOI: 10.4103/jmas.jmas_162_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pancreaticobiliary diseases and choledocholithiasis are common in elderly patients. Endoscopic treatment of biliary stones represents a well-established mini-invasive technique. However, limited data are available regarding the treatment of 'difficult' biliary stones, especially in the elderly population. The aim of our study is to evaluate the efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients ≥85 years of age with complex biliary stones. Materials and Methods From January 2015 to January 2017, data from ERCP procedures performed for complex biliary stones were retrospectively collected. The patients were divided into two groups based on their age: Group A - aged 85 years or older (n = 110) and Group B - aged 65 years or younger (n = 62). Demographic data, success, complications and recurrence rates for both groups were reported. Results Chronic comorbidities (86.3% vs. 24.2%; P < 0.001) and use of antithrombotic drugs (48.2% vs. 19.3%; P < 0.001) were more frequent in the elderly. The technical success rate (95.4% vs. 96.7%; P > 0.6) and complication rate (8.2% vs. 13%; P > 0.2) were not statistically different among the two groups. Periampullary diverticula (PAD) were observed more frequently in Group A (38.1% vs. 17.7%; P < 0.006). More patients from Group B underwent cholecystectomy during the same admission (8.2% vs. 42.3%; P < 0.001). The recurrence rate was not different among the groups (7.6% vs. 5%; P > 0.5). PAD was identified as the risk factor for recurrence (P < 0.02). Conclusion ERCP in the elderly was found to be a safe procedure, carrying a high degree of success for the treatment of difficult biliary stones.
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Affiliation(s)
- Pavlos Antypas
- Department of Emergency, Endoscopy Unit, Policlinico Umberto I Sapienza University of Rome; Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Cereatti
- Department of Medical, Gastroenterology and Endoscopy Unit, ASST Cremona, Cremona, Italy
| | - Fausto Fiocca
- Department of Emergency, Endoscopy Unit, Policlinico Umberto I Sapienza University of Rome, Rome, Italy
| | - Annalisa Cappello
- Department of Emergency, Endoscopy Unit, Policlinico Umberto I Sapienza University of Rome, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Fanello
- Department of Emergency, Endoscopy Unit, Policlinico Umberto I Sapienza University of Rome, Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Donatelli
- Interventional Endoscopy Unit, Private Hospital Des Peupliers-Ramsay Santé, Paris, France
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17
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Sadeghi A, Dooghaie Moghadam A, Jamshidizade S, Norouzinia M, Jamshidfar N, Hosseini P. Comparison of endoscopic balloon dilatation potency using balloons size more or less than 15 mm in the treatment of large bile duct stones: a clinical trial study. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:S112-S117. [PMID: 35154610 PMCID: PMC8817744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/02/2021] [Indexed: 11/02/2022]
Abstract
AIM The present study was performed on patients with large bile duct stones to compare clinical outcomes and complications of balloon dilatation treatment between two sizes of balloons, < 15 mm and ≥ 15 mm. BACKGROUND in 1982, the endoscopic papillary balloon dilatation (EPBD) method was presented by Staritz to reduce bleeding and perforation risk of large bile duct stones. METHODS Patients with large bile duct stones admitted to Taleghani hospital from December 2018 to December 2019 who were the candidates for balloon dilation with limited sphincterotomy. Patients were randomly divided into two groups. In group B, a ≥ 15 mm balloon was used, and in group A, a balloon <15 mm was used. The clinical results of balloon dilation and its complications were recorded and compared. RESULTS Most patients had 1 or 2 large bile duct stones, and there was no significant difference in the number of stones. Extraction was successful in 92.8% of group B and 85.7% of group A without significant differences (P = 0.8). Pancreatitis, hemorrhage, cholangitis, and perfusion occurred in 8%, 4.2%, 1.4%, and 2.8% of group B subjects and also in 10%, 2.8%, 0%, and 1.4% of group A subjects, respectively, and the difference between the two groups was not significant. CONCLUSION Generally, this study results showed that balloon size did not have a significant effect on the success rate of bile duct stones. Moreover, considering the lack of significant association between balloon dilatation size and the occurrence of post-endoscopic complications such as pancreatitis, it seems that large-size dilatation has no serious clinical risk.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arash Dooghaie Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shaghayegh Jamshidizade
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohsen Norouzinia
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Jamshidfar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parna Hosseini
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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18
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Sabbah M, Nakhli A, Bellil N, Ouakaa A, Bibani N, Trad D, Elloumi H, Gargouri D. Predictors of failure of endoscopic retrograde pancreatocholangiography during common bile duct stones. Heliyon 2020; 6:e05515. [PMID: 33294669 PMCID: PMC7683307 DOI: 10.1016/j.heliyon.2020.e05515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/13/2020] [Accepted: 11/11/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography associated with sphincterotomy and stone extraction with balloon or Dormia basket represents the gold standard for the management of common bile duct stones. The aim of our study were to investigate the predictors of failure of standard endoscopic techniques during the management of common bile duct stones. METHODS A retrospective study including all endoscopic retrograde cholangiopancreatography for common bile duct stones between January 2014 and December 2017 was conducted. First line treatment was based on endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and balloon or Dormia extraction. Second line endoscopic treatment was based on macrodilatation of Oddi sphincter, mechanical lithotripsy, biliary stent or nasobiliary drain placement. Predictors of failure of standard endoscopic techniques were sought by uni and multivariate analysis (SPSS software, p significant if < 0.05). RESULTS One hundred eighty one patients (mean age 64 years and sex ratio M/W = 0.4) were included. Main indications for endoscopic retrograde cholangiopancreatography were residual or recurrent lithiasis (67.4%, n = 122). Cholangiography revealed multiple stones in 53 patients with an average size of 12.5mm [3-40]. The success rate of first line treatment was 61.9%. Independent predictors of failure of standard endoscopic techniques (failure of papillary cannulation or stone extraction) according to multivariate analysis were: an age greater than 65 years OR 0.516 [0.272-0.979], an intra-diverticular papilla OR 0.179 [0.035-0.914], a common bile duct diameter greater than 15 mm OR 0.161 [0.068-0.385] and a stenosis of the common bile duct OR 0.068 [0.008-0.605]. The success rate of the second line treatment was 73%. CONCLUSION Endoscopic retrograde cholangiopancreatography results in a successful clearance of the common bile duct in almost two-thirds of patients. In case of predictors of failure, alternative techniques can increase this rate.
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Affiliation(s)
- Meriam Sabbah
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Abdelwahab Nakhli
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Nawel Bellil
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Asma Ouakaa
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Norsaf Bibani
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Dorra Trad
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Héla Elloumi
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
| | - Dalila Gargouri
- Department of Gastroenterology, Habib Thameur Hospital, Tunisia
- Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia
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19
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Galetti F, Moura DTHD, Ribeiro IB, Funari MP, Coronel M, Sachde AH, Brunaldi VO, Franzini TP, Bernardo WM, Moura EGHD. Cholangioscopy-guided lithotripsy vs. conventional therapy for complex bile duct stones: a systematic review and meta-analysis. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2020; 33:e1491. [PMID: 32609255 PMCID: PMC7325696 DOI: 10.1590/0102-672020190001e1491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. AIM To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. METHODS Search was based in Medline, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. RESULTS Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I²=0%), mean fluoroscopy time (MD=-0.14 CI -1.60, 1.32/I²=21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I²=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD=27.89 CI: 16.68, 39.10/I²=0%). In observational studies, the successful endoscopic clearance rate was 88.29% (CI95: 86.9%-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50±6 min for session and the number of sessions to clear bile duct was 1.5±0.18. The adverse event rate was 8.7% (CI95: 7%-10.9%). CONCLUSIONS For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.
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Affiliation(s)
- Facundo Galetti
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Diogo Turiani Hourneaux de Moura
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
- Divisão de Gastroenterologia, Hepatologia e Endoscopia, Brigham and Women´s Hospital, Harvard Medical School, Boston, Massachusetts, EUA
| | - Igor Braga Ribeiro
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mateus Pereira Funari
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Martin Coronel
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Amit H Sachde
- Divisão de Gastroenterologia, Hepatologia e Endoscopia, Brigham and Women´s Hospital, Harvard Medical School, Boston, Massachusetts, EUA
| | - Vitor Ottoboni Brunaldi
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Tomazo Prince Franzini
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wanderley Marques Bernardo
- Unidade de Endoscopia Gastrointestinal, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
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20
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Forbes N, Elmunzer BJ, Allain T, Chau M, Koury HF, Bass S, Belletrutti PJ, Cole MJ, Gonzalez-Moreno E, Kayal A, Kumar P, Mohamed R, Turbide C, Buret AG, Heitman SJ. Infection control in ERCP using a duodenoscope with a disposable cap (ICECAP): rationale for and design of a randomized controlled trial. BMC Gastroenterol 2020; 20:64. [PMID: 32164535 PMCID: PMC7066768 DOI: 10.1186/s12876-020-01200-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/20/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangio-pancreatography (ERCP) is commonly performed in the management of pancreatic and biliary disease. Duodenoscopes are specialized endoscopes used to perform ERCP, and inherent to their design, a high rate of persistent bacterial contamination exists even after automated reprocessing and disinfection. Consequently, in recent years, ERCP has been associated with infection transmission, leading to several fatal patient outbreaks. Due to increasing fears over widespread future duodenoscope-related outbreaks, regulatory bodies have called for alterations in the design of duodenoscopes. A duodenoscope has recently been developed that employs a disposable cap. This novel design theoretically eliminates the mechanism behind persistent bacterial contamination and infection transmission. However, there are no data demonstrating persistent bacterial contamination rates, technical success rates, or clinical outcomes associated with these duodenoscopes. METHODS A parallel arm randomized controlled trial will be performed for which 520 patients will be recruited. The study population will consist of consecutive patients undergoing ERCP procedures for any indication at a high-volume tertiary care centre in Calgary, Alberta, Canada. Patients will be randomized to an intervention group, that will undergo ERCP with a novel duodenoscope with disposable cap, or to a control group who will undergo ERCP with a traditional duodenoscope. Co-primary outcomes will include persistent bacterial contamination rates (post automated reprocessing) and ERCP technical success rates. Secondary outcomes include clinical success rates, overall and specific early and late adverse event rates, 30-day mortality and healthcare utilization rates, procedure and reprocessing times, and ease of device use. DISCUSSION The ICECAP trial will answer important questions regarding the use of a novel duodenoscope with disposable cap. Specifically, persistent bacterial contamination, technical performance, and relevant clinical outcomes will be assessed. Given the mortality and morbidity burden associated with ERCP-related infectious outbreaks, the results of this study have the capacity to be impactful at an international level. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov (NCT04040504) on July 31, 2019.
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Affiliation(s)
- Nauzer Forbes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Thibault Allain
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Millie Chau
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Hannah F Koury
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sydney Bass
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Martin J Cole
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Emmanuel Gonzalez-Moreno
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Ahmed Kayal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Puja Kumar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Rachid Mohamed
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Christian Turbide
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Andre G Buret
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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21
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Hormati A, Ghadir MR, Hasanpour Dehkordi A, Yadollahi F, Salehitali S, Afifian M. Consequences of Stenting and Endoscopic Papillary Balloon Dilatation in Treatment of Large and Multiple Common Bile Duct Stones. Middle East J Dig Dis 2019; 11:205-210. [PMID: 31824623 PMCID: PMC6895848 DOI: 10.15171/mejdd.2019.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although stenting for the treatment of large and multiple common bile duct stones has been acceptable to everyone, its efficacy and outcome have not been studied in comparison with other endoscopic procedures. The purpose of this study was to compare the consequences of stenting and endoscopic papilla balloon dilatation for the treatment of large and multiple common bile duct stones. METHODS In a double-blind clinical trial, of 431 patients with bile duct stones referred to the treatment center, 64 patients with multiple common bile duct stones ( ≥ 3) and more than 15 cm were selected for the study, then by random allocation rule the participants were allocated in two groups. They were entered into two different endoscopic papillary balloon dilatation (EPBD) and common bile ducts stenting treatments so that both procedures were performed by a person. Both groups were assessed from the point of views therapeutic outcomes such as duct cleaning, pancreatitis, isolated pain, and duct rupture. Data were collected by a self-made questionnaire that was used before and after the procedure to obtain the needed information. Then data were analyzed using SPSS software version 22 and descriptive and analytical tests were used as appropriated. RESULTS Although the duct cleaning and the complete removal of the stones in the stenting treatment procedure was 93.8%, and in EPBD was 78.3%, no significant difference was observed between the two groups (p = 0.14). Pancreatitis significantly increased after the first and second endoscopic retrograde cholangiopancreatography (ERCP) in the stent group compared with EPBD (p = 0.02). Also, the most frequent cases of isolated pain were in the endoscopic group EPBD (p = 0.0). However, the occurrence of perforation after first ERCP and EPBD was zero, but in the second stage of ERCP, 3.3% of the patients had perforations (p = 0.99). The results indicated that the shape of the stone (circular and angled) was not effective in the result of treatment in the two groups. CONCLUSION The results of this study indicated that in case of experience and skill in conducting the ERCP, common bile duct stenting is still the first line of treatment for large and multiple stones of the common bile ducts.
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Affiliation(s)
- Ahmad Hormati
- Assistant Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran.,Assistant Professor, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran
| | - Mohammad Reza Ghadir
- Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
| | - Ali Hasanpour Dehkordi
- Associate Professor, School of Allied Medical Sciences, Shahrekord, University of Medical Sciences, Shahrekord, Iran
| | - Farshad Yadollahi
- Medical Resident, Medical College, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shahriar Salehitali
- Assistant Professor , School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahboobeh Afifian
- MSc of Health Information Technology of Tehran University of Medical Sciences, Tehran, Iran
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22
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Bisogni D, Manetti R, Talamucci L, Rossi M, Puntili R, Staderini F, Boni L, Naspetti R. Efficacy and indications of dilation-assisted stone extraction for retrieval of difficult common bile duct stones: Results and data analysis of a single Italian referral center for bilio-pancreatic disease treatment. Minerva Med 2019; 112:653-655. [PMID: 31638360 DOI: 10.23736/s0026-4806.19.06100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Damiano Bisogni
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy -
| | - Roberto Manetti
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
| | - Luca Talamucci
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
| | - Michele Rossi
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
| | - Rachele Puntili
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
| | - Fabio Staderini
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
| | - Luca Boni
- Clinical Trial Center (CTC), Careggi Teaching Hospital, Florence, Italy
| | - Riccardo Naspetti
- Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi Teaching Hospital, Florence, Italy
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23
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De Silva SL, Pathirana AA, Wijerathne TK, Gamage BD, Dassanayake BK, De Silva MM. Transabdominal Ultrasonography in Symptomatic Choledocholithiasis - Usefulness in Settings with Limited Resources. J Clin Imaging Sci 2019; 9:31. [PMID: 31508266 PMCID: PMC6712550 DOI: 10.25259/jcis-38-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis. Methods: This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results. Results: A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms (P < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant (P < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%. Conclusion: Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC.
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Affiliation(s)
| | - Ajith Aloka Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Thejana Kamil Wijerathne
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Bawantha Dilshan Gamage
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Mohan Malith De Silva
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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24
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Rinchinov VB, Plekhanov AN, Ludupova EY. [Various endoscopic transpapilary interventions for choledocholithiasis]. Khirurgiia (Mosk) 2019:60-64. [PMID: 31317942 DOI: 10.17116/hirurgia201906160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial. MATERIAL AND METHODS There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy. RESULTS The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2. CONCLUSION Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.
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Affiliation(s)
- V B Rinchinov
- Semashko Republic Clinical Hospital, Ministry of Health of Republic of Buryatia, Ulan-Ude, Russia
| | - A N Plekhanov
- Buryat State University, Ulan-Ude, Russia; Irkutsk Research Center for Surgery and Traumatology, Irkutsk, Russia
| | - E Yu Ludupova
- Semashko Republic Clinical Hospital, Ministry of Health of Republic of Buryatia, Ulan-Ude, Russia
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25
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Brewer Gutierrez OI, Raijman I, Shah RJ, Elmunzer BJ, Webster GJ, Pleskow D, Sherman S, Sturgess RP, Sejpal DV, Ko C, Maurano A, Adler DG, Mullady DK, Strand DS, DiMaio CJ, Piraka C, Sharahia R, Dbouk MH, Han S, Spiceland CM, Bekkali NL, Gabr M, Bick B, Dwyer LK, Han D, Buxbaum J, Zulli C, Cosgrove N, Wang AY, Carr-Locke D, Kerdsirichairat T, Aridi HD, Moran R, Shah S, Yang J, Sanaei O, Parsa N, Kumbhari V, Singh VK, Khashab MA. Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones. Endosc Int Open 2019; 7:E896-E903. [PMID: 31281875 PMCID: PMC6609233 DOI: 10.1055/a-0889-7743] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background and study aims The role of the digital single-operator pancreatoscopy (D-SOP) with electrohydraulic (EHL) or laser lithotripsy (LL) in treating pancreatic ductal stones is unclear. We investigated the safety and efficacy of D-SOP with EHL or LL in patients with obstructing pancreatic duct stones.
Patients and methods Retrospective analysis of 109 patients who underwent D-SOP for pancreatic stones at 17 tertiary centers in the United States and Europe from February 2015 to September 2017. Logistic regression was performed to identify factors associated with the need for more than one D-SOP with EHL/LL.
Results Most patients were males (70.6 %),mean age 54.7 years. Fifty-nine (54.1 %) underwent EHL and 50 (45.9 %) underwent LL. Mean procedure time was longer in the EHL group (74.4 min vs 53.8 min; P < 0.001). Ducts were completely cleared (technical success) in 89.9 % of patients (94.1 % in EHL vs 100 % in LL; P = 0.243), achieved in a single session in 73.5 % of patients (77.1 % by EHL and 70 % by LL; P= 0.5).D-SOP failed in 11 patients (10.1 %); 6 patients were treated with extracorporeal shockwave lithotripsy (ESWL), 1 with surgery,1 with combined treatment (ESWL + D-SOP EHL) and 3 with other. Fourteen adverse events occurred in 11 patients (10.1 %). Patients with more than three ductal stones were more likely to have technical failure compared to those with less than three stones (17 % vs. 4.8 %; P = 0.04). Having more than three stones was independently associated with the need for more than one D-SOC EHL/LL session (OR 2.94, 95 % CI 1.13 – 7.65).
Conclusion D-SOP with EHL or LL is effective and safe in patients with pancreatic ductal stones.
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Affiliation(s)
| | - Isaac Raijman
- Greater Houston Gastroenterology, Texas, United States
| | - Raj J. Shah
- Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Douglas Pleskow
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
| | - Richard P. Sturgess
- Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
| | - Divyesh V. Sejpal
- Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
| | - Christopher Ko
- Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
| | - Attilio Maurano
- University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology University of Utah School of Medicine, Utah, United States
| | - Daniel K. Mullady
- Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Daniel S. Strand
- Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
| | - Christopher J. DiMaio
- Division of Gastroenterology Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, United States
| | - Cyrus Piraka
- Henry Ford Hospital, Detroit, Michigan, United States
| | - Reem Sharahia
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | - Mohamad H. Dbouk
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Samuel Han
- Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
| | - Clayton M. Spiceland
- Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Moamen Gabr
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Benjamin Bick
- Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
| | - Laura K. Dwyer
- Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
| | - Dennis Han
- Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
| | - James Buxbaum
- Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
| | - Claudio Zulli
- University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Natalie Cosgrove
- Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
| | - David Carr-Locke
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | | | - Hanaa Dakour Aridi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Robert Moran
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Shawn Shah
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Vikesh K. Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States,Corresponding author Mouen A. Khashab, MD Johns Hopkins Hospital1800 Orleans StreetSheikh Zayed TowerBaltimore, MD 21287+1-410-502-7010
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26
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Kuo CM, Chiu YC, Liang CM, Wu CK, Lu LS, Tai WC, Kuo YH, Wu KL, Chuah SK, Kuo CH. The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones. BMC Gastroenterol 2019; 19:93. [PMID: 31215401 PMCID: PMC6582576 DOI: 10.1186/s12876-019-1017-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound. METHODS We enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications. RESULTS The limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12-61) min vs. 23.5 (17-68) min vs. 25.0 (14-60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group. CONCLUSIONS Limited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.
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Affiliation(s)
- Chung-Mou Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Chung-Huang Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan.
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27
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Hori T. Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation. World J Gastroenterol 2019; 25:1531-1549. [PMID: 30983814 PMCID: PMC6452235 DOI: 10.3748/wjg.v25.i13.1531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.
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Affiliation(s)
- Tomohide Hori
- Department of Hepato-Biliary-Pancreatic Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Haseeb A, Freeman ML. Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Treatment of Bile Duct Stones. ACTA ACUST UNITED AC 2019; 17:221-230. [PMID: 30945095 DOI: 10.1007/s11938-019-00234-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To review the current literature focusing on the indications, efficacy, and safety of endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) with or without endoscopic sphincterotomy (EST) in the treatment of bile duct stones. • EPBD without EST is associated with a higher risk of post-procedural pancreatitis and lower rate of stone clearance than EST alone. • EPBD without EST should be at least 2 min in duration, and placement of a pancreatic stent and other measures to reduce pancreatitis risk should be considered. • EPBD without EST is most useful to reduce risk of bleeding in patients with coagulopathy. • EPLBD combined with EST can be used as an alternative or adjunct to mechanical lithotripsy in the removal of large or difficult bile duct stones. • EPLBD combined with EST results in fewer complications than EST alone for removal of bile duct stones.
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Affiliation(s)
- Abdul Haseeb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Martin L Freeman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
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De Silva WSL, Pathirana AA, Wijerathne TK, Gamage BD, Dassanayake BK, De Silva MM. Epidemiology and disease characteristics of symptomatic choledocholithiasis in Sri Lanka. Ann Hepatobiliary Pancreat Surg 2019; 23:41-45. [PMID: 30863806 PMCID: PMC6405359 DOI: 10.14701/ahbps.2019.23.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 12/22/2022] Open
Abstract
Backgrounds/Aims Published data on choledocholithiasis in Sri Lanka is scarce. This study was conducted to determine epidemiological, clinical and endoscopic characteristics of choledocholithiasis in Sri Lanka. Methods This was a retrospective study of consecutive patients for a period of three years until April 2016. The sample included patients from many parts of the island. Patients were selected from the endoscopy database of the unit and the data were collected from the records of the patients. Results A total of 253 patients were included in the study. The mean age of the patients was 53.6 years. Patients presented with obstructive jaundice (58.5%), cholangitis (25.3%), biliary colic or upper abdominal pain (14.2%) and acute biliary pancreatitis (1.8%). There were 26 (10.3%) post cholecystectomy patients. Concomitant gallbladder stones were found in 173 patients (68.4%). Juxta-papillary diverticula were found in 36 patients (14.2%). Twenty-one (8.3%) and nine patients (3.6%) were found to have choledochal cysts and common bile duct strictures, respectively. Stones were commonly found in the distal common bile duct (68.4%). A majority of the patients had a single stone (47.8%). In 209 patients (79.6%), the size of the largest stones measured between 0.5–1.5 cm. Conclusions Choledocholithiasis is a disease affecting middle-aged population with predominance among females in Sri Lanka. Patients with symptomatic choledocholithiasis commonly present with obstructive jaundice. In the present study, most of the stones were formed in anatomically normal biliary systems. Stones were predominantly distal, single and measured 0.5–1.5 cm in size. The observed features were favorable features for successful endoscopic clearance. None of the patients included in the study had primary CBD stones according to the available criteria.
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Affiliation(s)
| | - Ajith Aloka Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Thejana Kamil Wijerathne
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Bawantha Dilshan Gamage
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | | | - Mohan Malith De Silva
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
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Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis. ACG Case Rep J 2018; 5:e60. [PMID: 30214909 PMCID: PMC6119204 DOI: 10.14309/crj.2018.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 05/07/2018] [Indexed: 01/29/2023] Open
Abstract
A biliary enteric fistula (BEF) is a rare, abnormal communication between any segment of the biliary tree with any portion of the small or large intestine. BEF is more frequently diagnosed with the increasingly widespread use of endoscopic retrograde cholangiopancreatography. Different theories have been postulated regarding the etiology of this fistula formation, with the most likely cause being gallstones. Treatment modalities, ranging from conservative management to surgical reconstruction, show varying levels of success. We present a case of BEF secondary to large common bile duct stones, successfully treated with endoscopic sphincterotomy (EST) followed by papillary balloon dilatation, and we briefly discuss large stone retrieval in the setting of atypical anatomy.
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Borges AC, Almeida PCD, Furlani SMT, Cury MDS, Pleskow DK. ERCP PERFORMANCE IN A TERTIARY BRAZILIAN CENTER: FOCUS ON NEW RISK FACTORS, COMPLICATIONS AND QUALITY INDICATORS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1348. [PMID: 29947682 PMCID: PMC6049994 DOI: 10.1590/0102-672020180001e1348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/30/2018] [Indexed: 01/14/2023]
Abstract
Background: ERCP can lead to complications, which can be prevented by the recognition of risk factors. Aim: To identify these risk factors, with quality evaluation. Methods: Retrospective study in a Brazilian hospital in 194 patients, excluding surgically altered anatomy. Results: 211 ERCPs were performed: 97.6% were therapeutic, 83.4% were started by trainees, with deep cannulation rate of 89.6%. Precut was needed in 16.6% of the ERCPs and classic sphincterotomy in 67.3%, with 75.4% of ductal clearance at single session and 8.0% of technical failure. Inacessible papillas ocurred in 2.5% of cases. There were 2.5% of late complications and 16% of early complications. Multivariate analysis identified six predictors for early complications: fistulotomy precut (OR=3.4, p=0.010), difficult cannulation (OR=21.5, p=0.002), attending’s procedural time (OR=2.4, p=0.020), choledocholithiasis (adjusted OR=1.8, p=0.015), cannulation time (adjusted OR=3.2, p=0.018) and ERCP duration (adjusted OR=2.7, p=0.041). Conclusion: Six risk factors for post-ERCP complications were identified. ERCP duration and cannulation time are suggested as new potential quality indicators.
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Affiliation(s)
- Alana Costa Borges
- Zilda Arns Hospital and Maternity, Gastrointestinal Endoscopy, Fortaleza, CE, Brasil
| | | | | | - Marcelo de Sousa Cury
- SCOPE Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy, Campo Grande, MS, Brasil
| | - Douglas K Pleskow
- Beth Israel Deaconess Medical Center, Center for Advanced Endoscopy, Boston, Massachusetts,USA
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Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. Clin Gastroenterol Hepatol 2018; 16:918-926.e1. [PMID: 29074446 DOI: 10.1016/j.cgh.2017.10.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/19/2017] [Accepted: 10/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. METHODS We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. RESULTS The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P < .001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P = .31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P = .20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26-21.2; P = .02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .001). CONCLUSIONS In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.
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Abstract
PURPOSE OF REVIEW In 10-15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these "difficult bile duct stones." RECENT FINDINGS Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy. Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these "difficult" bile duct stones.
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Affiliation(s)
- Murad Aburajab
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200, West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Kulwinder Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200, West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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Saito H, Kadono Y, Kamikawa K, Urata A, Imamura H, Matsushita I, Kakuma T, Tada S. The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis. Intern Med 2018; 57:469-477. [PMID: 29151506 PMCID: PMC5849540 DOI: 10.2169/internalmedicine.9123-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts.
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Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Japan
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Japan
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Loh WL, Tung JYM, Tan THY, Tan LT, Tan S, Ngoi SS. Novel use of a balloon dilatation catheter to enable mechanical lithotripsy of difficult common bile duct stones after initial failed attempt: A case report. Int J Surg Case Rep 2018; 43:9-12. [PMID: 29414504 PMCID: PMC5907686 DOI: 10.1016/j.ijscr.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Difficult and large common bile duct stones can be crushed and removed using a mechanical lithotripter. Very often the lack of working space within the common bile duct causing the failure of mechanical lithotripsy would inevitably mean repeat or further invasive procedures. PRESENTATION OF CASE A patient with large and multiple common bile duct stones underwent ERCP, and initial deployment of a mechanical lithotripter failed due to the lack of working space within the common bile duct. A through-the-scope (TTS) dilator was utilized to increase the working space before successful deployment of the mechanical lithotripter, and subsequent clearance of all stones within the same setting. DISCUSSION We herein describe a novel and ingenious technique of utilizing a through-the-scope (TTS) dilator in helping to expand the space within the common bile duct to allow for full deployment of a mechanical lithotripter and successful clearance of common bile duct stones. This method can be easily applied by advanced endoscopists and is expected to lead to increased success rates of difficult common bile duct stones clearance in a single setting. CONCLUSION Use of TTS dilators to increase working space within the common bile duct can be useful in increasing the success rates of mechanical lithotripsy in the setting of large and multiple common bile duct stones.
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Affiliation(s)
- Wei-Liang Loh
- Singapore General Hospital, Outram Road, 169608, Singapore.
| | | | | | - Li Ting Tan
- Gleneagles Hospital, 6A Napier Road, 258500, Singapore
| | - Shaun Tan
- Gleneagles Hospital, 6A Napier Road, 258500, Singapore
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谢 明, 梁 国. 浅谈影响ERCP操作的制约因素. Shijie Huaren Xiaohua Zazhi 2017; 25:1735-1742. [DOI: 10.11569/wcjd.v25.i19.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
内镜下逆行性胆胰管造影术(endoscopic retrograde cholangiopancreatography, ERCP)由于具有创伤小、时间短的优点, 已在胆胰疾病的诊治方面具有举足轻重的作用, 尤其在胆总管结石、胆囊切除术后的胆管复发结石的治疗方面已经成为了首选. 但随着ERCP的广泛开展和认识的不断提高, 大量研究显示局部解剖因素, 尤其是十二指肠周围憩室、乳头嵌顿结石和乳头狭窄是影响ERCP操作成功的主要解剖因素. 同时医护患三者间的配合也是影响ERCP操作成功的重要原因. 本文系统复习相关文献资料, 对ERCP操作失败的原因作一综述.
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Sun GQ, Gao BF, Li GJ, Lei YL, Li J. Application of remifentanil for conscious sedation and analgesia in short-term ERCP and EST surgery. Medicine (Baltimore) 2017; 96:e6567. [PMID: 28422846 PMCID: PMC5406062 DOI: 10.1097/md.0000000000006567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aims to observe and evaluate the use of remifentanil in conscious sedation and analgesia for the safety and comfort of patients undergoing short-term endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST).Sixty-eight patients who underwent ERCP and EST were randomly divided into two groups: research group and control group. Patients in the research group were intravenously injected with remifentanil (80-2/3* age) for 1 to 2 minutes, combined with the intravenous injection of propofol (20-30 mg) during the course of treatment. ERCP surgery was performed when Ramsay sedation scale (RSS) score reached 2-3. During the surgery, patients were closely monitored for cough symptoms, aspiration, and respiratory and circulatory system performance, and timely treatment was performed. Sedative drugs were not given in patients in the control group.In research group, the circulatory and respiratory depression of patients was mild, only one patient needed to be treated, and there was no arrhythmia requiring treatment. Five patients had respiratory depression (blood oxygen saturation decreased to <90%), which was immediately corrected. There were no interruptions during surgery due to body movement, cough, or aspiration.The use of remifentanil for conscious sedation and analgesia can be broadly applied in short-term ERCP, which greatly improves patient comfort during the surgery. This approach may bear promise for a widespread use in future clinical practice.
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Abstract
Choledocholithiasis occurs in up to approximately 20% of patients with cholelithiasis. A majority of stones form in the gallbladder and then pass into the common bile duct, where they generate symptoms, due to biliary obstruction. Confirmatory diagnosis of choledocholithiasis is made with advanced imaging, including magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Treatment varies locally; however, ERCP with sphincterotomy is most commonly employed with a high degree of success. Difficult anatomy and difficult stone burden require advanced surgical, endoscopic, and percutaneous techniques to extract or expel biliary stones. Knowledge of these treatment strategies will optimize outcomes.
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Affiliation(s)
- Christopher Molvar
- Department of Radiology, Section of Vascular and Interventional Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Bryan Glaenzer
- Department of Radiology, Section of Vascular and Interventional Radiology, Loyola University Medical Center, Maywood, Illinois
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Cho YS, Park SH, Jun BG, Lee TH, Choi HJ, Cha SW, Moon JH, Cho YD, Kim SJ. New technique of endoscopic sphincterotomy with iso-tome® to incise the distal papillary roof in patients with choledocholiths and choledochoduodenal fistula. Gut Liver 2015; 9:231-8. [PMID: 25287164 PMCID: PMC4351031 DOI: 10.5009/gnl14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS It is sometimes difficult to incise the dis-tal papillary roof (PR) completely in patients with choledocho-liths and choledochoduodenal fistula (CDF). The Iso-Tome® (MTW-Endoskopie W. Haag KG), which is helpful in prevent-ing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome® for cutting the distal PR. METHODS Between May 2003 and July 2012, 35 pa-tients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome® until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. RESULTS Spontaneous or artificial CDF occurred in four and 31 pa-tients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapap-illary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. CONCLUSIONS The new technique of ES with the Iso-tome® is feasible and useful for effectively incising the distal PR in patients with CDF and choledocho-liths. (Gut Liver, 2015;9231-238).
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Affiliation(s)
- Young Sin Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sang Heum Park
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Baek Gyu Jun
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyun Jong Choi
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sang Woo Cha
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Ho Moon
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Deok Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sun Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
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Easler JJ, Sherman S. Endoscopic Retrograde Cholangiopancreatography for the Management of Common Bile Duct Stones and Gallstone Pancreatitis. Gastrointest Endosc Clin N Am 2015; 25:657-75. [PMID: 26431596 DOI: 10.1016/j.giec.2015.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary disease is a common cause of acute pancreatitis. Risk stratification for persistent pancreatobiliary obstruction is important for selecting a treatment approach. Most common bile duct stones are extracted with standard endoscopic techniques. However, prior foregut surgery, stones with extreme morphologic attributes, and at difficult positions within the biliary system are technically challenging and predict a need for advanced biliary endoscopic techniques. Surgical common bile duct exploration at the time of cholecystectomy is appropriate in centers with experience. We outline the options and approach for the clinician to successfully identify and manage patients with symptomatic choledocholithiasis with or without biliary pancreatitis.
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Affiliation(s)
- Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Sun WC, Chan HH, Lai KH, Tsai TJ, Lin HS, Lin KH, Wang KM, Kao SS, Chiang PH, Cheng JS, Hsu PI, Tsai WL, Chen WC, Li YD, Wang EM. The efficacy of endoscopic papillary balloon dilation for patients with acute biliary pancreatitis. Gastroenterol Res Pract 2015; 2015:575898. [PMID: 25949236 PMCID: PMC4408643 DOI: 10.1155/2015/575898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/22/2015] [Accepted: 03/29/2015] [Indexed: 02/06/2023] Open
Abstract
Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD) for the treatment of acute biliary pancreatitis (ABP). Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73) were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD) in 149 patients. The mean dilating balloon size was 10.5 mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2%) adverse events and 2 (1.1%) intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease.
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Affiliation(s)
- Wei-Chih Sun
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Hoi-Hung Chan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- College of Pharmacy and Health Care, Tajen University, Pingtung 907, Taiwan
| | - Kwok-Hung Lai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung 831, Taiwan
| | - Kung-Hung Lin
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Kai-Ming Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Sung-Shuo Kao
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Po-Hung Chiang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Jin-Shiung Cheng
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Wei-Lun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Chi Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Yun-Da Li
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - E-Ming Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
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Park JS, Jeong S, Han JY, Lee DH. Endoscopic balloon dilation lithotripsy for difficult bile duct stones. Dig Dis Sci 2014; 59:1898-901. [PMID: 24756316 DOI: 10.1007/s10620-014-3154-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/03/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIM Endoscopic treatment for removal of large or impacted bile duct stones is challenging, and may not be successful. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation lithotripsy (EBDL) as a means of treating difficult extrahepatic bile duct stones refractory to failed conventional endoscopic treatments. PATIENTS AND METHODS The patients were included in the indication of EBDL only if stones were confirmed as brown-pigmented stones or recurrent. Balloon dilation was performed using a balloon dilation catheter in order to crush large and/or impacted stones at the common hepatic duct or common bile duct level in seven cases, and then fragmented stones were removed using a basket and/or an extraction balloon catheter. RESULTS The median diameter of the balloons used for EBDL was 32.4 ± 10.5 mm (range, 12.4-52.1). Balloon dilation was performed for 60 s per session. The mean number of EBDL sessions required to crush stones was two (range, 1-5), the mean number of ERCP sessions required for complete stone removal was 2.4 ± 0.8 (range, 1-3), the overall procedure-related complication rate was 0% (0/7), and the success rate was 100% (7/7). CONCLUSION EBDL might be a safe and effective option for the treatment of large and impacted extrahepatic bile duct stones refractory to conventional endoscopic treatments.
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Affiliation(s)
- Jin-Seok Park
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
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Shi D, Yu CG. Comparison of Two Capture Methods for Endoscopic Removal of Large Common Bile Duct Stones. J Laparoendosc Adv Surg Tech A 2014; 24:457-61. [PMID: 24987842 DOI: 10.1089/lap.2013.0509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ding Shi
- Department of Gastroenterology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Cheng-Gong Yu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Bencini L, Tommasi C, Manetti R, Farsi M. Modern approach to cholecysto-choledocholithiasis. World J Gastrointest Endosc 2014; 6:32-40. [PMID: 24567790 PMCID: PMC3930888 DOI: 10.4253/wjge.v6.i2.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 01/01/2014] [Accepted: 01/15/2014] [Indexed: 02/05/2023] Open
Abstract
Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.
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Kim MJ, Cha SW, Cho YD. [Refractory bile duct stones occurring at hepaticoduodenostomy site]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 62:182-4. [PMID: 24199287 DOI: 10.4166/kjg.2013.62.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lawson RD, Savides T. Safely stretching our options for removing large CBD stones. Dig Dis Sci 2013; 58:894-6. [PMID: 23456501 DOI: 10.1007/s10620-013-2601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Li NP, Liu JQ, Zhou ZQ, Ji TY, Cai XY, Zhu QY. Ampulla dilation with different sized balloons to remove common bile duct stones. World J Gastroenterol 2013; 19:903-908. [PMID: 23431070 PMCID: PMC3574888 DOI: 10.3748/wjg.v19.i6.903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/07/2013] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the outcomes of ampulla dilation with different sized balloons to remove common bile duct (CBD) stones.
METHODS: Patients (n = 208) were divided into five groups based on the largest CBD stone size of < 5, 6-8, 8-12, 12-14, and > 14 mm. Patients underwent limited endoscopic sphincterotomy (EST) alone or limited EST followed by endoscopic papillary balloon dilation with 8, 10, 12 and 14 mm balloons, such that the size of each balloon did not exceed the size of the CBD. Short- and long-term outcomes, such as post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, perforation, bleeding, and pneumobilia were compared among the five groups.
RESULTS: The overall rate of successful stone removal in all groups was 100%, and all patients were cured. Eight (3.85%) patients had post-ERCP pancreatitis, none had perforations, and 6 (2.9%) had bleeding requiring transfusion. There were no significant differences in early complication rates among the five groups. We observed significant correlations between increased balloon size and the short- and long-term rates of post-ERCP pneumobilia. Post-ERCP pancreatitis and bleeding correlated significantly with age, with post-ERCP pancreatitis occurring more frequently in patients aged < 60 years, and bleeding occurring more frequently in patients aged > 70 years. We observed a significant correlation between patient age and the diameter of the largest CBD stone, with stones > 12 mm occurring more frequently in patients > 60 years old.
CONCLUSION: Choosing a balloon size based on the largest stone diameter is safe and effective for removing CBD stones. Balloon size should not exceed 15 mm.
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Harada R, Maguchi H, Takahashi K, Katanuma A, Osanai M, Yane K, Hashigo S, Kaneko M, Katoh R, Katoh S. Large balloon dilation for the treatment of recurrent bile duct stones prevents short-term recurrence in patients with previous endoscopic sphincterotomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:498-503. [DOI: 10.1007/s00534-012-0579-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ryo Harada
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Hiroyuki Maguchi
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Kuniyuki Takahashi
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Akio Katanuma
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Manabu Osanai
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Kei Yane
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Syunpei Hashigo
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Maki Kaneko
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Ryusuke Katoh
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
| | - Shin Katoh
- Center for Gastroenterology; Teine-Keijinkai Hospital; 1-jo 12-chome, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan
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