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Chavan R, Bachkaniwala V, Gandhi C, Joshi V, Rajput S. Efficacy and safety of digital single-operator cholangioscopy-guided laser lithotripsy for remnant cystic duct stone-A single tertiary care center experience. Indian J Gastroenterol 2024; 43:841-844. [PMID: 37566182 DOI: 10.1007/s12664-023-01418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Radhika Chavan
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Maninagar, Ahmedabad, 380 008, India.
| | - Vatsal Bachkaniwala
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Maninagar, Ahmedabad, 380 008, India
| | - Chaiti Gandhi
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Maninagar, Ahmedabad, 380 008, India
| | - Vivek Joshi
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Maninagar, Ahmedabad, 380 008, India
| | - Sanjay Rajput
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Maninagar, Ahmedabad, 380 008, India
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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] [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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3
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Rey Rubiano AM, González-Teshima LY, Arango L, Blanco-Avellaneda C, Carvajal Gutiérrez JJ, Castaño-Llano R, Gómez Zuleta MA, González C, Peñaloza-Ramírez A, Pinilla Morales R, Pinto Carta R, Polanía Liscano HA, Rincón Sánchez RA, Sepúlveda Copete M, Vargas-Rubio R, Avendaño Capriles CA, García-Sierra AM, Yepes-Nuñez JJ. Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones. Surg Endosc 2024; 38:499-510. [PMID: 38148404 PMCID: PMC10830582 DOI: 10.1007/s00464-023-10569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/23/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones. METHODS ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks. RESULTS The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP. CONCLUSION For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.
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Affiliation(s)
- Adriana Margarita Rey Rubiano
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | | | - Lázaro Arango
- Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Department of Endoscopy and Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Union of surgeons, Zentria Group, Manizales, Caldas, Colombia.
| | - Camilo Blanco-Avellaneda
- Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
- Education and Research Group, Faculty of Education, Universidad El Bosque, Bogotá, D.C., Colombia
- Videoendoscopy Unit of Restrepo Ltda, Bogotá, D.C, Colombia
| | - Jhon Jaime Carvajal Gutiérrez
- Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Rodrigo Castaño-Llano
- Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia
- Institute of Cancerology, Clínica las Américas Auna, Medellín, Antioquia, Colombia
| | - Martin Alonso Gómez Zuleta
- Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
- Department of Internal Medicine, Gastroenterology Section, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia
| | - Carlos González
- Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia
- Department of Gastroenterology and Digestive Endoscopy, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
- Department of Gastroenterology, Clínica Colombia, Bogotá, D.C., Colombia
| | - Arecio Peñaloza-Ramírez
- Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
- Department of Gastroenterology, Hospital de San José, Bogotá, D.C., Colombia
| | - Raúl Pinilla Morales
- Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Renzo Pinto Carta
- Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia
- American Society for Gastrointestinal Endoscopy, Rochester, USA
| | - Héctor Adolfo Polanía Liscano
- Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia
- Endotek Ltda, Hospital Universitario Neiva, Neiva, Huila, Colombia
| | - Reinaldo Andrés Rincón Sánchez
- Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Clínica Shaio, Bogotá, D.C., Colombia
| | | | - Rómulo Vargas-Rubio
- Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
| | - Camilo Andrés Avendaño Capriles
- School of Medicine, Universidad del Norte, Barranquilla, Colombia
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrés Mauricio García-Sierra
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- School of Global Health Management and Informatics, University of Central Florida, Orlando, USA
| | - Juan José Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, D.C., Colombia.
- Colombia GRADE Network, Bogotá, D.C., Colombia.
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Anderloni A. Biliary cannulation in ERCP: you don't need to be a shark if you now can be sharp! Endoscopy 2023; 55:1043-1044. [PMID: 37722408 DOI: 10.1055/a-2164-9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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El Menabawey T, Mulay A, Graham D, Phillpotts S, Sethi A, Webster GJ. Predictors of success of conventional ERCP for bile duct stones and need for single-operator cholangioscopy. Endosc Int Open 2023; 11:E943-E951. [PMID: 37818453 PMCID: PMC10562053 DOI: 10.1055/a-2164-8557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023] Open
Abstract
Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy. Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression. Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence ( P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement ( P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session. Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy.
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Affiliation(s)
- Tareq El Menabawey
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Akhilesh Mulay
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - David Graham
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Simon Phillpotts
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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Mauro A, Mazza S, Scalvini D, Lusetti F, Bardone M, Quaretti P, Cobianchi L, Anderloni A. The Role of Cholangioscopy in Biliary Diseases. Diagnostics (Basel) 2023; 13:2933. [PMID: 37761300 PMCID: PMC10528268 DOI: 10.3390/diagnostics13182933] [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: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
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Amaral AC, Hussain WK, Han S. Cholangioscopy-guided electrohydraulic lithotripsy versus laser lithotripsy for the treatment of choledocholithiasis: a systematic review. Scand J Gastroenterol 2023; 58:1213-1220. [PMID: 37203215 DOI: 10.1080/00365521.2023.2214657] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Endoscopic management of large bile duct stones may be challenging and refractory to standard endoscopic retrograde cholangiopancreatography (ERCP) techniques. To this end, per-oral cholangioscopy (POC)-guided electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been increasingly utilized during ERCP. There are limited data, however, comparing EHL and LL in the management of choledocholithiasis. Therefore, the aim was to analyze and compare the efficacy of POC-guided EHL and LL for the treatment of choledocholithiasis. METHODS A database search on PubMed was performed selecting prospective English-language articles published by September 20th, 2022, in accordance with PRISMA guidelines. Studies selected included bile duct clearance as an outcome. RESULTS A total of 21 prospective studies (15 using LL, 4 using EHL, and 2 both) including 726 patients were included for analysis. Complete ductal clearance was achieved in 639 (88%) patients with 87 (12%) patients having incomplete ductal clearance. Patients treated with LL had an overall median stone clearance success rate of 91.0% (IQR, 82.7-95.5), whereas EHL achieved a median stone clearance success rate of 75.8% (IQR, 74.0-82.4), [p = .03]. CONCLUSIONS LL is a highly effective form of POC-guided lithotripsy for the treatment of large bile duct stones, particularly when compared to EHL. However, direct, head-to-head randomized trials are needed to identify the most effective form of lithotripsy for treating refractory choledocholithiasis.
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Affiliation(s)
- Anna Cecilia Amaral
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Waleed K Hussain
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Abstract
PURPOSE OF REVIEW Cholangioscopy is a mini-invasive endoscopic procedure, which consists in a direct intraductal visualization of the biliary tract. The purpose of this review is to summarize the technique, the clinical applications, as well as future perspectives of cholangioscopy. RECENT FINDINGS Numerous technologic advances during the last decades have allowed for an improved utility and functionality, leading to a broader use of this procedure, for diagnostic or therapeutic purposes, in the setting of biliary diseases. Novel tools and emerging indications have been developed and more are yet to come. SUMMARY Cholangioscopy can be performed by peroral, percutaneous transhepatic or intra-operative transcystic or transcholedochal access. Clinical applications of cholangioscopy are multiple, ranging from visual impression and optical guided biopsies of indeterminate biliary strictures to the management of difficult stones , guidance before biliary stenting and retrieval of migrated ductal stents. Multiple devices such as lithotripsy probes, biopsy forceps, snares and baskets have been developed to help achieve these procedures successfully.Cholangioscopy has improved the way biliary diseases can be visualized and treated. New technology, accessories, and applications are expected in the future.
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Silva-Santisteban A, Mehta N, Trasolini R, Stone J, Pleskow DK. Endoscopic holmium laser lithotripsy for therapy of Bouveret syndrome. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:115-117. [PMID: 36935808 PMCID: PMC10020008 DOI: 10.1016/j.vgie.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Video 1Video of holmium laser lithotripsy procedure.
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Affiliation(s)
- Andy Silva-Santisteban
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Neal Mehta
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Roberto Trasolini
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James Stone
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Douglas K Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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10
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Zhang WL, Ji R. Cystic duct stump stone removal by retrieval basket under direct visualization using a novel peroral choledochoscope. Endoscopy 2022; 55:E100-E101. [PMID: 36216264 PMCID: PMC9829795 DOI: 10.1055/a-1938-8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Wen-Lin Zhang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, P. R. China,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, P. R. China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, P. R. China,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, P. R. China,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
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Alexandrino G, Lopes L, Fernandes J, Moreira M, Araújo T, Campos S, Loureiro R, Figueiredo L, Lourenço LC, Horta D, Bana E Costa T, Costa P, Canena J. Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 Patients. Dig Dis Sci 2022; 67:4195-4203. [PMID: 34811629 DOI: 10.1007/s10620-021-07305-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. METHODS This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. RESULTS Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). CONCLUSIONS POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.
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Affiliation(s)
- Gonçalo Alexandrino
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Luís Lopes
- Gastroenterology Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), Universidade do Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João Fernandes
- Gastroenterology Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal.,Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Marta Moreira
- Gastroenterology Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Tarcísio Araújo
- Gastroenterology Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Sara Campos
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rui Loureiro
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Luísa Figueiredo
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | | | - David Horta
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Tiago Bana E Costa
- Gastroenterology Department, Hospital Egas Moniz - Centro Hospital Lisboa Ocidental, Lisbon, Portugal
| | - Patrício Costa
- School of Medicine, Life and Health Sciences Research Institute (ICVS), Universidade do Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Canena
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. .,Gastroenterology University Center - Hospital Cuf Tejo, Lisbon, Portugal. .,Gastroenterology Department - Nova Medical School, Faculty of Medical Sciences, Hospital Cuf Tejo, Avenida 24 de Julho, 171A, 1350-352, Lisbon, Portugal. .,Cintesis - Center for Health Technology and Services Research, Porto, Portugal.
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12
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Machicado JD, Raijman I, Shah RJ. Future of Cholangioscopy. Gastrointest Endosc Clin N Am 2022; 32:583-596. [PMID: 35691698 DOI: 10.1016/j.giec.2022.03.002] [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: 02/07/2023]
Abstract
This article highlights the current status of cholangioscopy. In addition, the authors present their view on the future directions of cholangioscopy, including novel clinical applications, the need for technologic developments, and the expansion on the use of cholangioscopy in clinical practice. The authors envision that cholangioscopy will eventually become a conventional tool in the shelf of any biliary endoscopist. Future technologic improvements including optics, maneuverability, and full device accessories, plus the introduction of real-time artificial intelligence algorithms, will optimize the outcomes of cholangioscopy, but baseline proficiency in therapeutic endoscopic retrograde cholangiopancreatography will remain necessary for its successful utilization.
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Affiliation(s)
- Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 East Medical Center Drive, Floor 3, Reception D, Ann Arbor, MI 48109, USA
| | - Isaac Raijman
- Texas Digestive Disease Consultants, 4100 South Sheperd Drive, Houston, TX 77098, USA
| | - Raj J Shah
- Pancreas and Biliary Endoscopy, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Mail Stop F735, Aurora, CO 80045, USA.
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13
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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques. Medicina (B Aires) 2022; 58:medicina58010120. [PMID: 35056428 PMCID: PMC8779004 DOI: 10.3390/medicina58010120] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/14/2022] Open
Abstract
Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.
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14
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Lee YN. Recent update of therapeutic application of peroral cholangioscopy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea
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15
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Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Aprile F, Renga A, Mutignani M. Endoscopic intraductal lithotripsy of biliary stones using thulium laser: preliminary results of a single-center experience. Lasers Med Sci 2021; 37:1361-1364. [PMID: 34308504 DOI: 10.1007/s10103-021-03382-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy.
| | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Francesco Pugliese
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Marcello Cintolo
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Francesca Aprile
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Alessio Renga
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Massimiliano Mutignani
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
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16
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Abstract
Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrograde cholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or a basket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are large CBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage these stones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for large CBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the cost of the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted in a tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization of the stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. This technique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significant technical complications.
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Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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