Utility of Direct Peroral Cholangioscopy Using a Multibending Ultraslim Endoscope for Difficult Common Bile Duct Stones
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Background/Aims: Treatment options for difficult bile duct stones are limited. Direct peroral cholangioscopy (POC)-guided lithotripsy may be an option. A newly developed multibending (MB) ultraslim endoscope has several structural features optimized for direct POC. We evaluated the utility of direct POC using an MB ultraslim endoscope for lithotripsy in patients with difficult bile duct stones. Methods: Twenty patients with difficult bile duct stones, in whom stone removal using conventional endoscopic methods, including mechanical lithotripsy, had failed were enrolled from March 2018 to August 2019. Direct POC-guided lithotripsy was performed by electrohydraulic lithotripsy or laser lithotripsy. The primary outcome was complete ductal clearance, defined as the retrieval of all bile duct stones after lithotripsy confirmed by balloon-occluded cholangiography and/or direct POC. Results: The technical success rate of direct POC was 100% (20/20), and the free-hand insertion rate was 95% (19/20). Direct POC-guided lithotripsy, attempted by electrohydraulic lithotripsy in nine patients (45%) and laser lithotripsy in 11 patients (55%), was successful in 95% (19/20) of the patients. Complete ductal clearance after direct POC-guided lithotripsy was achieved in 95% (19/20) of patients. Patients required a median of 2 (range, 1–3) endoscopic retrograde cholangiopancreatography sessions for complete stone removal. Adverse event was observed in one patient (5%) with hemobilia and was treated conservatively. Conclusions: Direct POC using an MB ultraslim endoscope was safe and effective for lithotripsy in patients with difficult bile duct stones.
Abstract
Background/Aims: Treatment options for difficult bile duct stones are limited. Direct peroral cholangioscopy (POC)-guided lithotripsy may be an option. A newly developed multibending (MB) ultraslim endoscope has several structural features optimized for direct POC. We evaluated the utility of direct POC using an MB ultraslim endoscope for lithotripsy in patients with difficult bile duct stones. Methods: Twenty patients with difficult bile duct stones, in whom stone removal using conventional endoscopic methods, including mechanical lithotripsy, had failed were enrolled from March 2018 to August 2019. Direct POC-guided lithotripsy was performed by electrohydraulic lithotripsy or laser lithotripsy. The primary outcome was complete ductal clearance, defined as the retrieval of all bile duct stones after lithotripsy confirmed by balloon-occluded cholangiography and/or direct POC. Results: The technical success rate of direct POC was 100% (20/20), and the free-hand insertion rate was 95% (19/20). Direct POC-guided lithotripsy, attempted by electrohydraulic lithotripsy in nine patients (45%) and laser lithotripsy in 11 patients (55%), was successful in 95% (19/20) of the patients. Complete ductal clearance after direct POC-guided lithotripsy was achieved in 95% (19/20) of patients. Patients required a median of 2 (range, 1–3) endoscopic retrograde cholangiopancreatography sessions for complete stone removal. Adverse event was observed in one patient (5%) with hemobilia and was treated conservatively. Conclusions: Direct POC using an MB ultraslim endoscope was safe and effective for lithotripsy in patients with difficult bile duct stones.
참고문헌 (16)
- Carr-Locke DL, "Therapeutic role of ERCP in the management of suspected common bile duct stones", Gastrointest Endosc, 56(6 Suppl), pp.S170~S174 (2002)
- ASGE Standards of Practice Committee, "The role of ERCP in benign diseases of the biliary tract", Gastrointest Endosc, 81, pp.795~803 (2015)
- 문종호, "The Role of Direct Peroral Cholangioscopy Using an Ultraslim Endoscope for Biliary Lesions: Indications, Limitations, and Complications", Clinical Endoscopy, 46(5), pp.537~539 (2013), 대한소화기내시경학회
- Lee YN, "Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones", Endoscopy, 44, pp.819~824 (2012)
- Lee YN, "Prospective randomized trial of a new multibending versus conventional ultra-slim endoscope for peroral cholangioscopy without device or endoscope assistance(with video)", Gastrointest Endosc, 91, pp.92~101 (2020)
- Lee YN, "A newly modified access balloon catheter for direct peroral cholangioscopy by using an ultraslim upper endoscope(with videos)", Gastrointest Endosc, 83, pp.240~247 (2016)
- ASGE Standards of Practice Committee, "Adverse events associated with ERCP", Gastrointest Endosc, 85, pp.32~47 (2017)
- Manes G, "Endoscopic management of common bile duct stones : European Society of Gastrointestinal Endoscopy(ESGE)guideline", Endoscopy, 51, pp.472~491 (2019)
- Nguyen NQ, "Cholangioscopy and pancreatoscopy(with videos)", Gastrointest Endosc, 70, pp.1200~1210 (2009)
- Choi HJ, "Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope(with videos)", Gastrointest Endosc, 69, pp.935~940 (2009)
- Larghi A, "Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope : a feasibility study", Gastrointest Endosc, 63, pp.853~857 (2006)
- Korrapati P, "The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures : a systematic review and meta-analysis", Endosc Int Open, 4, pp.E263~E275 (2016)
- Itoi T, "Clinical evaluation of a prototype multi-bending peroral direct cholangioscope", Dig Endosc, 26, pp.100~107 (2014)
- Beyna T, "Direct retrograde cholangioscopy with a new prototype double-bending cholangioscope", Endoscopy, 48, pp.929~933 (2016)
- Kondo H, "Development of fatal systemic gas embolism during direct peroral cholangioscopy under carbon dioxide insufflation", Endoscopy, 48(Suppl 1), pp.E215~E216 (2016)
- Efthymiou M, "Air embolism complicated by left hemiparesis after direct cholangioscopy with an intraductal balloon anchoring system", Gastrointest Endosc, 75, pp.221~223 (2012)